Early Assessment of Health Care Utilization Among a Workforce Population With Access to Primary Care Practices With Electronic Health Records

2013 ◽  
Vol 36 (3) ◽  
pp. 260-268 ◽  
Author(s):  
Samantha F. De Leon ◽  
Lucas Pauls ◽  
Sarah C. Shih ◽  
Thomas Cannell ◽  
Jason J. Wang
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Electronic Health Records ◽  
Health Care Utilization ◽  
Care Utilization ◽  
Early Assessment ◽  
Health Records ◽  
Care Practices ◽  
Access To Primary Care ◽  
Primary Care Practices

Centralized Care Management Support for “High Utilizers” in Primary Care Practices at an Academic Medical Center

2014 ◽  
Vol 15 (1) ◽  
pp. 26-33 ◽  
Author(s):  
Brent C. Williams ◽  
Jamie L. Paik ◽  
Laura L. Haley ◽  
Gina M. Grammatico
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Utilization ◽  
Emergency Room ◽  
Care Management ◽  
Care Utilization ◽  
Management Support ◽  
Care Practices ◽  
Primary Care Practices ◽  
Centralized Care

Although evidence of effectiveness is limited, care management based outside primary care practices or hospitals is receiving increased attention. The University of Michigan (UM) Complex Care Management Program (CCMP) provides care management for uninsured and underinsured, high-utilizing patients in multiple primary care practices. To inform development of optimal care management models, we describe the CCMP model and characteristics and health care utilization patterns of its patients. Of a consecutive series of 49 patients enrolled at CCMP in 2011, the mean (SD) age was 48 (±14); 23 (47%) were women; and 29 (59%) were White. Twenty-eight (57%) had two or more chronic medical conditions, 39 (80%) had one or more psychiatric condition, 28 (57%) had a substance abuse disorder, and 11 (22%) were homeless. Through phone, e-mail, and face-to-face contact with patients and primary care providers (PCPs), care managers coordinated health and social services and facilitated access to medical and mental health care. Patients had a mean (SD) number of hospitalizations and emergency room (ER) visits in 6 months prior to enrollment of 2.2 (2.5) and 4.2 (4.3), respectively, with a nonstatistically significant decrease in hospitalizations, hospital days, and emergency room visits in 6 months following enrollment in CCMP. Centralized care management support for primary care practices engages high-utilizing patients with complex medical and behavioral conditions in care management that would be difficult to provide through individual practices and may decrease health care utilization by these patients.

scholarly journals Association between Electronic Health Records and Health Care Utilization

2015 ◽  
Vol 06 (01) ◽  
pp. 42-55 ◽  
Author(s):  
A. Edwards ◽  
L.M. Kern ◽  
R. Kaushal ◽  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Electronic Health Records ◽  
Health Care Utilization ◽  
Primary Care Providers ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Care Providers ◽  
Health Records ◽  
Electronic Health

SummaryBackground: The federal government is investing approximately $20 billion in electronic health records (EHRs), in part to address escalating health care costs. However, empirical evidence that provider use of EHRs decreases health care costs is limited.Objective: To determine any association between EHRs and health care utilization.Methods: We conducted a cohort study (2008–2009) in the Hudson Valley, a multi-payer, multi-provider community in New York State. We included 328 primary care physicians in predominantly small practices (median practice size four primary care physicians), who were caring for 223,772 patients. Data from an independent practice association was used to determine adoption of EHRs. Claims data aggregated across five commercial health plans was used to characterize seven types of health care utilization: primary care visits, specialist visits, radiology tests, laboratory tests, emergency department visits, hospital admissions, and readmissions. We used negative binomial regression to determine associations between EHR adoption and each utilization outcome, adjusting for ten physician characteristics.Results: Approximately half (48%) of the physicians were using paper records and half (52%) were using EHRs. For every 100 patients seen by physicians using EHRs, there were 14 fewer specialist visits (adjusted p < 0.01) and 9 fewer radiology tests (adjusted p = 0.01). There were no significant differences in rates of primary care visits, laboratory tests, emergency department visits, hospitalizations or readmissions.Conclusions: Patients of primary care providers who used EHRs were less likely to have specialist visits and radiology tests than patients of primary care providers who did not use EHRs.Citation: Kaushal R, Edwards A, Kern LM, with the HITEC Investigators. Association between electronic health records and health care utilization. Appl Clin Inf 2015; 6: 42–55http://dx.doi.org/10.4338/ACI-2014-10-RA-0089

Acute Health Care Utilization among Food-insecure Children in Primary Care Practices

2016 ◽  
Vol 27 (3) ◽  
pp. 1143-1158 ◽  
Author(s):  
Deepak Palakshappa ◽  
Saba Khan ◽  
Chris Feudtner ◽  
Alexander G. Fiks
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Utilization ◽  
Care Utilization ◽  
Acute Health Care ◽  
Care Practices ◽  
Primary Care Practices

scholarly journals Electronic Health Records and Patient Safety

2015 ◽  
Vol 06 (01) ◽  
pp. 136-147 ◽  
Author(s):  
D. Gans ◽  
J. White ◽  
R. Nath ◽  
J. Pohl ◽  
C. Tanner
Keyword(s):  
Primary Care ◽  
Patient Safety ◽  
Electronic Health Records ◽  
Medication Management ◽  
Health Records ◽  
Safety Practices ◽  
Care Practices ◽  
Electronic Health ◽  
Primary Care Practices ◽  
Promote Patient Safety

Summary Background: The role of electronic health records (EHR) in enhancing patient safety, while substantiated in many studies, is still debated. Objective: This paper examines early EHR adopters in primary care to understand the extent to which EHR implementation is associated with the workflows, policies and practices that promote patient safety, as compared to practices with paper records. Early adoption is defined as those who were using EHR prior to implementation of the Meaningful Use program. Methods: We utilized the Physician Practice Patient Safety Assessment (PPPSA) to compare primary care practices with fully implemented EHR to those utilizing paper records. The PPPSA measures the extent of adoption of patient safety practices in the domains: medication management, handoffs and transition, personnel qualifications and competencies, practice management and culture, and patient communication. Results: Data from 209 primary care practices responding between 2006–2010 were included in the analysis: 117 practices used paper medical records and 92 used an EHR. Results showed that, within all domains, EHR settings showed significantly higher rates of having workflows, policies and practices that promote patient safety than paper record settings. While these results were expected in the area of medication management, EHR use was also associated with adoption of patient safety practices in areas in which the researchers had no a priori expectations of association. Conclusions: Sociotechnical models of EHR use point to complex interactions between technology and other aspects of the environment related to human resources, workflow, policy, culture, among others. This study identifies that among primary care practices in the national PPPSA database, having an EHR was strongly empirically associated with the workflow, policy, communication and cultural practices recommended for safe patient care in ambulatory settings. Citation: Tanner C, Gans D, White J, Nath R, Pohl J. Electronic health records and patient safety – co-occurrence of early EHR implementation with patient safety practices in primary care settings. Appl Clin Inf 2015; 6: 136–147http://dx.doi.org/10.4338/ACI-2014-11-RA-0099

The Financial And Nonfinancial Costs Of Implementing Electronic Health Records In Primary Care Practices

2011 ◽  
Vol 30 (3) ◽  
pp. 481-489 ◽  
Author(s):  
Neil S. Fleming ◽  
Steven D. Culler ◽  
Russell McCorkle ◽  
Edmund R. Becker ◽  
David J. Ballard
Keyword(s):  
Primary Care ◽  
Electronic Health Records ◽  
Health Records ◽  
Care Practices ◽  
Electronic Health ◽  
Primary Care Practices

scholarly journals Scaling-up social needs screening in practice: a retrospective, cross-sectional analysis of data from electronic health records from Bronx county, New York, USA

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e053633
Author(s):  
Kevin P Fiori ◽  
Caroline G Heller ◽  
Anna Flattau ◽  
Nicole R Harris-Hollingsworth ◽  
Amanda Parsons ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
Electronic Health Records ◽  
Social Care ◽  
Social Needs ◽  
Cross Sectional ◽  
Health Records ◽  
Care Practices ◽  
Electronic Health ◽  
Primary Care Practices

ObjectivesThere has been renewed focus on health systems integrating social care to improve health outcomes with relatively less related research focusing on ‘real-world’ practice. This study describes a health system’s experience from 2018 to 2020, following the successful pilot in 2017, to scale social needs screening of patients within a large urban primary care ambulatory network.SettingAcademic medical centre with an ambulatory network of 18 primary care practices located in an urban county in New York City (USA).ParticipantsThis retrospective, cross-sectional study used electronic health records of 244 764 patients who had a clinical visit between 10 April 2018 and 8 December 2019 across any one of 18 primary care practices.MethodsWe organised measures using the RE-AIM framework domains of reach and adoption to ascertain the number of patients who were screened and the number of providers who adopted screening and associated documentation, respectively. We used descriptive statistics to summarise factors comparing patients screened versus those not screened, the prevalence of social needs screening and adoption across 18 practices.ResultsBetween April 2018 and December 2019, 53 093 patients were screened for social needs, representing approximately 21.7% of the patients seen. Almost one-fifth (19.6%) of patients reported at least one unmet social need. The percentage of screened patients varied by both practice location (range 1.6%–81.6%) and specialty within practices. 51.8% of providers (n=1316) screened at least one patient.ConclusionsThese findings demonstrate both the potential and challenges of integrating social care in practice. We observed significant variability in uptake across the health system. More research is needed to better understand factors driving adoption and may include harmonising workflows, establishing unified targets and using data to drive improvement.

Electronic Health Records are Associated with Higher Quality in Primary Care Practices

2009 ◽  
Author(s):  
Mark Friedberg ◽  
Kathryn Coltin ◽  
Dana Safran ◽  
Marguerite Dresser ◽  
Alan Zaslavsky ◽  
...  
Keyword(s):  
Primary Care ◽  
Electronic Health Records ◽  
Health Records ◽  
Care Practices ◽  
Electronic Health ◽  
Primary Care Practices
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