Regional Data Exchange to Improve Care for Veterans After Non-VA Hospitalization

NCT02689076 | Completed Results

• 1 other identifier: IIR 14-049
• Study Type: interventional
• Target: 796
• Locations: 1 country
• Sites: 2

Brief Summary

Among older VA patients who have Medicare coverage, 43% use both VA and non-VA (Medicare-covered) services. VA and non-VA providers are often uninformed about encounters, treatments and test results provided in the other system. The overall objective of this project is to examine the impact of VA provider notification of non-VA hospitalization or emergency department (ED) visit using electronic health information exchange (HIE), along with provision of post-hospital care coordination services. The investigators will examine the impact of these approaches on preventing hospital readmission, increasing provider follow-up, improving patient's self-knowledge, and preventing medication errors. The investigators will also examine the effect of these approaches on VA and non-VA costs. Finally the investigators will examine the acceptance of these approaches among VA and non-VA providers. The study sample will consist of Veterans followed in geriatrics or primary care clinics at the Bronx and Indianapolis VAs who are older than 65. The investigators will monitor patients for non-VA hospital admission or ED visit using technology provided by health information exchange organizations. Patients will be assigned to enhanced or control treatment groups. For both groups the VA provider will receive an electronic notification of a non-VA hospital admission or ED visit if it occurs. For the enhanced group, a care transitions coordinator will deliver post-hospital coordination services during a home and/or VA facility visit and follow-up phone calls over 1 month. The investigators' analyses will compare effects of notification-plus-coordination versus notification-only on health care outcomes. The investigators will conduct interviews with intervention team members, patients, VA and non-VA staff, and other stakeholders to ascertain the barriers and facilitators to implementation of these approaches.

Conditions

Patient Readmission; Adverse Drug Event; Cost

Keywords

Patient transfer; Patient care management; Health information exchange

Outcome Measures

Primary Outcomes (1)

• Number of Participants With Hospital Readmission

  Percentage of patients with VA and non-VA hospital admission or readmission 90 days after non-VA hospital or ED discharge (or, if the patient is not discharged home, 90 days after discharge home from a rehabilitation facility)

  90 days

Secondary Outcomes (3)

• Number of Participants With Scheduled Follow-up

  30 days

• Number of High-risk Medication Discrepancies

  30 days

• Care Transitions Measure Score

  30 days

Study Arms (3)

HIE Notification plus Care Coordination

EXPERIMENTAL

VA provider notification of non-VA hospitalization via electronic health information exchange (HIE) plus post-hospital geriatric care transitions intervention

Other: HIE Notification; Other: Care transitions intervention

HIE Notification alone

ACTIVE COMPARATOR

VA provider notification of non-VA hospitalization via electronic health information exchange (HIE) followed by usual post-hospital care

Other: HIE Notification

Usual Care (No HIE Notification and No Care Coordination)

NO INTERVENTION

Absence of VA provider notification of non-VA hospitalization via HIE plus Absence of post-hospital geriatric care transitions intervention \[Usual Care\]

Interventions

HIE Notification OTHER

VA provider notification of non-VA hospitalization or ED visit via electronic health information exchange

HIE Notification alone; HIE Notification plus Care Coordination

Care transitions intervention OTHER

Post-hospital geriatrics care transitions coordinator provides home visit and telephone support for 30 days after hospital discharge

HIE Notification plus Care Coordination

Eligibility Criteria

• Age: 65 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)

You may qualify if:

• established patient in a Bronx VA or Indianapolis VA geriatrics or primary care clinic
• years or older
• be consented in the local health information exchange
• have utilized any non-VA services in the previous two years, including:
• nursing
• lab
• physician
• pharmacy
• and/or hospital services

You may not qualify if:

• Refusal to sign informed consent or consent to access local health information exchange
• Enrolled in hospice at baseline
• Enrolled in Geriatric Resources and Care for Elders (GRACE) program (Indianapolis) at baseline

Sponsors & Collaborators

• VA Office of Research and Development: lead

Study Sites (2)

Richard L. Roudebush VA Medical Center, Indianapolis, IN

Indianapolis, Indiana, 46202-2884, United States

Location

James J. Peters VA Medical Center, Bronx, NY

The Bronx, New York, 10468-3904, United States

Location

Related Publications (8)

• Dixon BE, Boockvar KS. Event Notification in Support of Population Health: The Promise and Challenges from a Randomized Controlled Trial. Stud Health Technol Inform. 2017;245:1357.

  PMID: 29295436 RESULT

• Dixon BE, Schwartzkopf AL, Guerrero VM, May J, Koufacos NS, Bean AM, Penrod JD, Schubert CC, Boockvar KS. Regional data exchange to improve care for veterans after non-VA hospitalization: a randomized controlled trial. BMC Med Inform Decis Mak. 2019 Jul 4;19(1):125. doi: 10.1186/s12911-019-0849-1.

  PMID: 31272427 RESULT

• Franzosa E, Traylor MH, Aquino VG, Judon K, Schwartzkopf A, Dixon BE, Boockvar K. Care Team Members' Perceptions of an Informatics Intervention to Improve Geriatric Care Across Multiple sites. [Abstract]. Innovation in aging. 2020 Dec 16; 4(Supplement_1):519.

  RESULT

• Franzosa E, Traylor M, Judon KM, Guerrero Aquino V, Schwartzkopf AL, Boockvar KS, Dixon BE. Perceptions of event notification following discharge to improve geriatric care: qualitative interviews of care team members from a 2-site cluster randomized trial. J Am Med Inform Assoc. 2021 Jul 30;28(8):1728-1735. doi: 10.1093/jamia/ocab074.

  PMID: 33997903 RESULT

• Kartje R, Dixon BE, Schwartzkopf AL, Guerrero V, Judon KM, Yi JC, Boockvar K. Characteristics of Veterans With Non-VA Encounters Enrolled in a Trial of Standards-Based, Interoperable Event Notification and Care Coordination. J Am Board Fam Med. 2021 Mar-Apr;34(2):301-308. doi: 10.3122/jabfm.2021.02.200251.

  PMID: 33832998 RESULT

• Koufacos NS, May J, Judon KM, Franzosa E, Dixon BE, Schubert CC, Schwartzkopf AL, Guerrero VM, Traylor M, Boockvar KS. Improving Patient Activation among Older Veterans: Results from a Social Worker-Led Care Transitions Intervention. J Gerontol Soc Work. 2022 Jan;65(1):63-77. doi: 10.1080/01634372.2021.1932003. Epub 2021 May 30.

  PMID: 34053407 RESULT

• Dixon BE, Judon KM, Schwartzkopf AL, Guerrero VM, Koufacos NS, May J, Schubert CC, Boockvar KS. Impact of event notification services on timely follow-up and rehospitalization among primary care patients at two Veterans Affairs Medical Centers. J Am Med Inform Assoc. 2021 Nov 25;28(12):2593-2600. doi: 10.1093/jamia/ocab189.

  PMID: 34597411 RESULT

• Boockvar KS, Koufacos NS, May J, Schwartzkopf AL, Guerrero VM, Judon KM, Schubert CC, Franzosa E, Dixon BE. Effect of Health Information Exchange Plus a Care Transitions Intervention on Post-Hospital Outcomes Among VA Primary Care Patients: a Randomized Clinical Trial. J Gen Intern Med. 2022 Dec;37(16):4054-4061. doi: 10.1007/s11606-022-07397-5. Epub 2022 Feb 23.

  PMID: 35199262 RESULT

MeSH Terms

Conditions

Drug-Related Side Effects and Adverse Reactions

Condition Hierarchy (Ancestors)

Chemically-Induced Disorders

Results Point of Contact

• Title: Kimberly M. Judon
• Organization: James J. Peters VA Medical Center

Kimberly.Judon@va.gov

718-584-9000

Study Officials

• Kenneth S Boockvar, MD MS

  James J. Peters Veterans Affairs Medical Center

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: FED
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 18, 2016
• First Posted: February 23, 2016
• Study Start: March 14, 2016
• Primary Completion: April 5, 2020
• Study Completion: April 5, 2020
• Last Updated: July 27, 2023
• Results First Posted: March 24, 2021

Record last verified: 2023-07

Data Sharing

• IPD Sharing: Will not share

Locations

US (2)