OBJECTIVES: To characterize the drivers of the use of electronic health information exchange (HIE) by skilled nursing facilities (SNFs) to access patient hospital data during care transitions. STUDY DESIGN: Explanatory, sequential mixed-methods study. Quantitative data from an audit log captured HIE use by 3 SNFs to retrieve hospitalization information for the 5487 patients discharged to their care between June 2014 and March 2017, along with patient demographic data. Qualitative inquiry included 16 interviews at the discharging hospital and HIE-enabled SNFs. METHODS: Multivariate probit models determined patient-level factors associated with SNF HIE use. These models informed subsequent in-depth, semistructured interviews to refine our understanding of usage patterns, as well as facilitators of and barriers to use. RESULTS: HIE was used by SNFs for 46% of patients for whom it was available; 29% of patients had records accessed within 3 days of hospital discharge. Overall HIE use was more likely for new versus returning SNF patients (3.8%; P <.001) and when a patient was discharged from the emergency department rather than an inpatient unit (6.8%; P = .027). HIE use was less likely on weekends (-4.3%; P = .036) and for more complex patients, as measured by length of stay (-0.4% per day; P ≤.001) or number of conditions (-0.3% per diagnosis; P ≤.001). Interviews revealed distinct HIE use cases across SNFs; perceiving ability to access information not otherwise available in paper discharge materials, as well as workflow integration, were critical facilitators of use during transitional care. CONCLUSIONS: HIE between hospitals and SNFs is underused. A mixed-methods approach is critical to understanding and explaining variation in implementation and use. Creating value requires hospitals and SNFs to codevelop system design, usage guidelines, and workflows that meaningfully integrate HIE into care delivery.
|Original language||English (US)|
|Journal||American Journal of Managed Care|
|State||Published - Jan 1 2019|
Bibliographical noteFunding Information:
Author Disclosures: Dr Adler-Milstein is principal investigator of a grant from Hartford Foundation on the related topic of hospital–skilled nursing facility information sharing. The remaining authors report no relationship or financial interest with any entity that would pose aconflict of interest withthe subject matter of this article.
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