The Impact of Health Information Exchange on In-Hospital and Postdischarge Mortality in Older Adults with Alzheimer Disease Readmitted to a Different Hospital Within 30 Days of Discharge: Cohort Study of Medicare Beneficiaries

• Type of Material: Article
• Authors: Sara Turbow, Emory University; Elizabeth Vaughan, Emory University; Steven Culler, Emory University; Kenneth Hepburn, Emory University; Kimberly Rask, Emory University; Molly Perkins, Emory University; Carolyn Clevenger, Emory University; Mohammed Ali, Emory University
• Language: English
• Date: 2023-01-01
• Publisher: JMIR
• Publication Version: Final Published Version
• Copyright Statement: ©Sara Turbow, Camille P Vaughan, Steven D Culler, Kenneth W Hepburn, Kimberly J Rask, Molly M Perkins, Carolyn K Clevenger, Mohammed K Ali. Originally published in JMIR Aging (https://aging.jmir.org), 10.03.2023.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.2196/41936
• Title of Journal or Parent Work: JMIR Aging
• Volume: 6
• Start Page: e41936
• End Page: e41936
• Grant/Funding Information: Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health (K23AG065505), by the Program for Retaining, Supporting, and Elevating Early-Career Researchers at Emory (PeRSEVERE) from the Emory School of Medicine, by a gift from the Doris Duke Charitable Foundation, and through the Georgia Clinical and Translational Science Alliance National Institutes of Health (award UL1-TR002378). This material is the result of work supported with resources and the use of facilities at the Atlanta Veterans Affairs Health Care System. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Department of Veterans Affairs.
• Keywords: electronic health information; information exchange; Alzheimer disease; older adults; readmissions; care fragmentation; health informatics; hospital system; mortality; information sharing; health information exchange
• Research Categories: Gerontology; Health Sciences, Health Care Management

Abstract

Background: Although electronic health information sharing is expanding nationally, it is unclear whether electronic health information sharing improves patient outcomes, particularly for patients who are at the highest risk of communication challenges, such as older adults with Alzheimer disease. Objective: To determine the association between hospital-level health information exchange (HIE) participation and in-hospital or postdischarge mortality among Medicare beneficiaries with Alzheimer disease or 30-day readmissions to a different hospital following an admission for one of several common conditions. Methods: This was a cohort study of Medicare beneficiaries with Alzheimer disease who had one or more 30-day readmissions in 2018 following an initial admission for select Hospital Readmission Reduction Program conditions (acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, and pneumonia) or common reasons for hospitalization among older adults with Alzheimer disease (dehydration, syncope, urinary tract infection, or behavioral issues). Using unadjusted and adjusted logistic regression, we examined the association between electronic information sharing and in-hospital mortality during the readmission or mortality in the 30 days following the readmission. Results: A total of 28,946 admission-readmission pairs were included. Beneficiaries with same-hospital readmissions were older (aged 81.1, SD 8.6 years) than beneficiaries with readmissions to different hospitals (age range 79.8-80.3 years, P<.001). Compared to admissions and readmissions to the same hospital, beneficiaries who had a readmission to a different hospital that shared an HIE with the admission hospital had 39% lower odds of dying during the readmission (adjusted odds ratio [AOR] 0.61, 95% CI 0.39-0.95). There were no differences in in-hospital mortality observed for admission-readmission pairs to different hospitals that participated in different HIEs (AOR 1.02, 95% CI 0.82-1.28) or to different hospitals where one or both hospitals did not participate in HIE (AOR 1.25, 95% CI 0.93-1.68), and there was no association between information sharing and postdischarge mortality. Conclusions: These results indicate that information sharing between unrelated hospitals via a shared HIE may be associated with lower in-hospital, but not postdischarge, mortality for older adults with Alzheimer disease. In-hospital mortality during a readmission to a different hospital was higher if the admission and readmission hospitals participated in different HIEs or if one or both hospitals did not participate in an HIE. Limitations of this analysis include that HIE participation was measured at the hospital level, rather than at the provider level. This study provides some evidence that HIEs can improve care for vulnerable populations receiving acute care from different hospitals.