The Impact of an Automated Patient Digital Engagement Platform on Revisit Reduction

Background Revisits within 30 days to an emergency department (ED), observation care unit, or inpatient setting following patient discharge continues to be a challenge, especially in urban settings. In addition to the consequences for the patient, these revisits have a negative impact on a health system’s finances in a value based care or global budget environment. Objective The objective was to evaluate the effectiveness of a customized automated digital patient engagement application (GetWell Loop) to prevent 30-day revisits after home discharge from an ED or hospital inpatient setting. Methods The LifeBridge Health Innovation Team collaborated with the GetWell Network to customize their patient engagement platform (GetWell Loop) with automated check-in questions and resources. An application link was emailed to adult patients discharged home from the ED. A retrospective study of ED visits for patients treated for general medicine and cardiology conditions (accounting for 24% of our adult ED discharges) between August 1, 2018, and December 31, 2018, was conducted using CRISP, Maryland’s state-designated health information exchange. We used this database to identify the index visits that experienced an emergency department visit, inpatient admission, or observation stay at any Maryland facility within 30 days of discharge. We also used data within GetWell Loop to track patient activation and engagement. The primary endpoint was a comparison of ED patients that experienced a 30-day revisit and who did or did not activate their GetWell Loop account. Secondary end points included overall activation rate and the rate of engagement as measured by the number of logins, alerts, and comments generated by patients through the platform. Statistical significance was calculated using the Fisher’s exact test with a P<.05. Results ED discharges who were treated for general medicine conditions (n=787) and activated their GetWell Loop account experienced a 30-day revisit rate of 18.9% compared to 25.2% who did not activate their account (P=.06). For patients treated for cardiology conditions (n=722), 10.5% of patients who activated their GetWell account experienced a 30-day revisit compared to 17.4% not activating their account (P=.02). During the course of this study, 26% of patients receiving an invite to use the digital platform activated their account (n=1652) logged in a total of 4006 times, generated 734 alerts, and submitted 297 open ended comments/questions. Conclusions These results indicate the potential value of digital health platforms to improve 30-day revisit rates. The strongest impact was observed amongst cardiology patients where the revisit rate is 39.8% lower for patients using GetWell Loop compared to general medicine patients where the relative difference is 25.2%. The results also indicate patients are willing to utilize a digital platform postdischarge to proactively engage in their own care. We attempted to control for potential selection bias that may impact this analysis given patient adoption and use of a digital platform by looking for differences in the subpopulations who did and did not activate the platform. LifeBridge Health is proving healthcare systems can leverage automated mobile platforms to successfully impact clinical outcomes at scale without compromising customer service and patient experience.

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The Impact of an Automated Patient Digital Engagement Application on Revisit Reduction (Preprint)

10.2196/preprints.17839 ◽

2020 ◽

Author(s):

Pothik Chatterjee ◽

Adam Michael Beck ◽

Jenna Ashley Levenson Brager ◽

Daniel James Durand

Keyword(s):

Health System ◽

Patient Engagement ◽

Information Exchange ◽

Digital Health ◽

General Medicine ◽

Inpatient Setting ◽

Hospital Inpatient ◽

Digital Engagement ◽

The Impact ◽

Improve Patient

BACKGROUND Revisits within 30-days to an emergency department (ED), observation care unit, or inpatient setting following patient discharge continue to be a challenge, especially in urban settings. In addition to the consequences for the patient, these revisits have a negative impact on a health system’s finances in a value based care or global budget environment. LifeBridge Health, a community health system in Maryland, implemented an automated patient digital engagement application as part of the overall organization’s digital health strategy to improve patient engagement and reduce revisits to the ED. OBJECTIVE To evaluate the effectiveness of a customized automated digital patient engagement application (GetWell Loop) to reduce 30-day revisits after home discharge from an ED or hospital inpatient setting. METHODS The LifeBridge Health Innovation Department and ED staff from two participating health system hospitals collaborated with the GetWell Network to customize their patient engagement application (GetWell Loop) with automated check-in questions and resources. An application link was e-mailed to adult patients discharged home from the ED. A retrospective study of ED visits for patients treated for general medicine and cardiology conditions between 8/1/2018 through 7/31/2019 was conducted using CRISP, Maryland’s state-designated health information exchange. We also used data within GetWell Loop to track patient activation and engagement. The primary endpoint was a comparison of ED patients that experienced a 30-day revisit and who did or did not activate their GetWell Loop account. Secondary end points included overall activation rate and the rate of engagement as measured by the number of logins, alerts, and comments generated by patients through the application. Statistical significance was calculated using the Fisher’s exact test with a P-value < 0.05. RESULTS Patients discharged from the ED who were treated for general medicine conditions (n=2087) and activated their GetWell Loop account experienced a 30-day revisit rate of 17.3% compared to 24.6% who did not activate their account (P<.001). For patients treated for cardiology conditions (n = 1779), 12.8% of patients who activated their GetWell account experienced a 30-day revisit compared to 17.7% not activating their account (P=.01). During this one-year study, 25% of all emergency patients receiving an invite to use the digital application activated their account (n=4125), logged in a total of 8935 times, generated 1911 alerts, and submitted 771 open ended comments/questions. CONCLUSIONS These results indicate the potential value of digital health applications to reduce 30-day revisit rates. The results also indicate patients are willing to utilize a digital application post-discharge to proactively engage in their own care. LifeBridge Health’s experience demonstrates that healthcare systems can leverage automated mobile applications to improve patient engagement and successfully impact clinical outcomes at scale.

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MP04: Interim analysis of the impact of the Emergency Department Transformation System on ambulance offload delay

CJEM ◽

10.1017/cem.2017.170 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S66

Author(s):

S. Pawa ◽

K. Van Aarsen ◽

A. Dukelow ◽

D. Lizotte ◽

M. Zheng

Keyword(s):

Emergency Department ◽

Negative Impact ◽

Positive Impact ◽

Tertiary Care ◽

Assessment Process ◽

Hospital Length Of Stay ◽

Initial Assessment ◽

Hospital Inpatient ◽

Chi Square Analysis ◽

The Impact

Introduction: Emergency Department Systems Transformation (EDST) is a bundle of Toyota Production System based interventions implemented in two London, Canada tertiary care Emergency Departments (ED) between April 2014 and July 2016 to improve patient care by increasing value and reducing waste. Some of the 17 primary interventions included computerized physician order entry optimization, staff schedule realignment, physician scorecards, and a novel initial assessment process. Offload delays are associated with longer hospital length of stay and delayed admission, and may increase morbidity and mortality. Delays also result in fewer circulating ambulances in the community. CIHI sets a benchmark of 30 minutes as an acceptable offload target. It is possible that EDST may have impacted offload times. Methods: Middlesex-London EMS provided offload times. Data was collected from London Health Sciences Centre including daily ED visit volumes, ED occupancy, offload nursing hours, and site variation. A binomial logistic regression analysis was performed to determine the impact of interventions and confounding variables on the proportion of patients meeting CIHI benchmark. A chi-square analysis was done comparing proportion of patients meeting the benchmark in the first 3 months versus the last 3 months to identify overall impact of EDST to date. Results: Increased offload nursing hours had a positive impact (p<0.001) on the proportion of offload times meeting the CIHI benchmark while increased ED visit volume and hospital inpatient volume had a significant negative impact (p<0.001). At both ED sites, the proportion of patients meeting the offload target ranged from 58-83% over the timeframe. There was a significant increase in the proportion of patients meeting the benchmark from the first quarter to the last quarter (69.6% vs 75.0%; 95% CI 3.45% to 7.38%, p=0.000). Specific interventions had varying degrees of impact on offload times. Conclusion: The proportion of patients meeting the benchmark offload time varied over the study timeframe but significantly increased with EDST implementation. Offload times are one of many outcomes we aim to improve with EDST and it remains an ongoing process as new interventions continue to be implemented. Once transformation is complete, future studies will focus on the impact of EDST on all ED flow metrics, and patient and provider satisfaction.

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Quick diagnostic unit integrated in an emergency department setting reduces medical admissions – an observational study

Journal of Hospital Administration ◽

10.5430/jha.v3n3p17 ◽

2013 ◽

Vol 3 (3) ◽

pp. 17 ◽

Cited By ~ 1

Author(s):

Dan Brun Petersen ◽

Thomas Andersen Schmidt

Keyword(s):

Internal Medicine ◽

Emergency Department ◽

General Medicine ◽

University Hospital ◽

First Year ◽

Special Focus ◽

Diagnostic Study ◽

Diagnostic Unit ◽

Number Of Patients ◽

The Impact

Background: Hospitals in countries with public health systems have recently adopted organizational changes to improve efficiency and resource allocation, and reducing inappropriate hospitalizations has been established as an important goal, as well as avoiding or buffering overcrowding in Emergency Departments (EDs). Aims: Our goal was to describe the impact of a Quick Diagnostic Unit established on January 1, 2012, integrated in an ED setting in a Danish public university hospital following its function for the first year. Design: Observational, descriptive and comparative study. Methods: Our sample comprised the total number of patients being admitted and discharged from the Department of Internal Medicine in 2011 and 2012, with special focus on the General Medicine Ward. Results: Compared with 2011 the establishment of the Quick Diagnostic Unit integrated in the Emergency Department resulted in the admittance and discharge of fewer patients (40%; p < .0001) to the hospital’s General Medicine Ward and 11.6% (p < .0001) fewer patients in the whole Department of Internal Medicine. Conclusions: A Quick Diagnostic Unit integrated in an ED setting represents a useful and fast track model for the diagnostic study and treatment of patients with simple internal medicine ailments, and also serves as a buffer for overcrowding of the ED.

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P003: Door-to-antibiotics and mortality for emergency department patients presenting with septic shock

CJEM ◽

10.1017/cem.2019.194 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S64

Author(s):

A. Aguanno ◽

K. Van Aarsen ◽

S. Pearce ◽

T. Nguyen

Keyword(s):

Emergency Department ◽

Septic Shock ◽

Linear Regression ◽

Hospital Discharge ◽

Statistical Significance ◽

Serum Lactate ◽

Secondary Outcome ◽

Clinical Equipoise ◽

Time To Antibiotics ◽

The Impact

Introduction: We examined our local sepsis patient population, and specifically our most vulnerable patients - those presenting to the emergency department (ED) in septic shock - for variables predictive of survival to hospital discharge. We applied the familiar ED paradigm of, “Door to,” to calculate the impact of time to antibiotics against patient survival to hospital discharge. Methods: Retrospective chart review of patients aged > = 18 years, presenting to tertiary care ED between 01 Nov 2014 and 31 Oct 2015. Patients determined to have sepsis if A) > = 2 SIRS criteria and ED suspicion of infection (ED acquisition of blood/urine cultures or antibiotic administration) and/or B) received ED or Hospital discharge diagnosis of sepsis (ICD-10 diagnostic codes A4xx and R65). Patients sub-classified with septic shock if A) triage SBP < = 90mmHg, B) triage MAP < = 65mmHg or C) serum lactate > = 4mmol/L. “Door Time” was defined as the earliest time recorded for the patient encounter, either the time the patient registered in the Emergency Department, or the triage time. A generalized linear model was performed with a binomial distribution using survival to discharge as the response variable. Age, sex, ED arrival method, time to antibiotics, ED serum lactate and ED serum glucose level were the predictor variables. Results: 13506 patient encounters met inclusion criteria (10980 unique patients). Linear regression of time to antibiotics against survival to hospital discharge failed to achieve statistical significance. Linear regression of the secondary outcome variables achieved statistical significance for age and serum lactate level. Per the model, as age increased by 1 year, the odds of dying prior to hospital discharge increased by 3.8% and as serum lactate increased by 1 mmol/L, odds of dying prior to hospital discharge increased by 11.1%. Conclusion: We found no association between time to antibiotic treatment and mortality. Causal relationships require randomized controlled trials, and this analysis contributes to clinical equipoise.

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138. Implementation of an Antimicrobial Stewardship Order Set in the Emergency Department at a Quaternary Care Facility

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.340 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S182-S182

Author(s):

Salma M . Al Shaqfa ◽

Rania M El Lababidi ◽

Wasim S El Nekidy ◽

Mohamed Hisham ◽

Rama Nasef ◽

...

Keyword(s):

Emergency Department ◽

Antimicrobial Stewardship ◽

Antimicrobial Therapy ◽

Care Facility ◽

Primary Study ◽

Inpatient Setting ◽

Evidence Based ◽

Number Of Patients ◽

The Impact ◽

Order Set

Abstract Background Implementation of antimicrobial stewardship (AS) interventions in the emergency department (ED) has been associated with improved patient outcomes. One potentially promising AS strategy is the implementation of an ED-specific, evidence-based antimicrobial order set. In this study, we aimed to examine the impact of implementing an ED-specific order set (EDOS) on the appropriateness of empiric antimicrobial therapy. Methods We conducted a pre-post quasi experimental study on 160 adult patients presenting to the ED with suspected or confirmed common infections at our quaternary healthcare facility. The EDOS was implemented in December 2020, providing evidence-based recommendations for the management of common infectious diseases. Data was collected between September 2019 and March 2020 for the pre-EDOS implementation group and between January 2021 and April 2021 for the post-EDOS implementation group. Pregnant women and patients with suspected or confirmed COVID-19 infection were excluded. Data were analyzed using two-sample T-test and mixed effects logistic regression. The primary study outcome was the appropriateness of antimicrobials selected, and the secondary outcomes were clinical and microbiologic cure, length of hospital stay, Clostridioides difficile infection, and the number of changes in antimicrobial therapy on transition to inpatient setting. Results A total of 100 ED patients pre-EDOS implementation and 60 patients post-EDOS implementation were compared. At baseline, patients in the post-EDOS group were older (59.83±20.30 years vs. 50.17±19.97 years, P=0.0037). A higher number of patients in the post-EDOS group had a history of multiple comorbidities (76.67% vs. 54%, P=0.0039). There was a higher rate of appropriate antimicrobial use in the post-EDOS group as compared to the pre-EDOS group (88.3% vs. 50%, P< 0.001). Longer hospital stays were observed in the post-EDOS group (P=0.0005). Clinical cure was similar between the two groups (96.6% vs. 94%, P=0.4568). Conclusion In our study, we observed higher rates of appropriate antimicrobial selection after implementation of an EDOS. Use of an EDOS may represent a valuable AS intervention to guide appropriate antimicrobial prescribing in the ED, and larger studies are needed to confirm those findings. Disclosures All Authors: No reported disclosures

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Differences in Admission Rates Among Patients Treated with Apixaban Vs. Warfarin for Venous Thromboembolism in the Emergency Department

Blood ◽

10.1182/blood-2019-125845 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 2157-2157

Author(s):

Steven Deitelzweig ◽

Patrick Hlavacek ◽

Jack Mardekian ◽

Lisa Rosenblatt ◽

Cristina Russ ◽

...

Keyword(s):

Emergency Department ◽

Venous Thromboembolism ◽

Charlson Comorbidity Index Score ◽

Inpatient Setting ◽

Index Event ◽

Lower Likelihood ◽

Warfarin Treatment ◽

Comorbidity Index ◽

The Impact ◽

Hospital Characteristics

Background: With fixed-dose regimens, fast onset of action, and no requirement for routine monitoring, direct oral anticoagulants (DOACs) have facilitated the treatment of venous thromboembolism (VTE) on an outpatient basis. Little is known regarding the outcomes of patients who recieve DOACs in the emergency department (ED). Thus, in this study we evaluated hospitalization LOS and costs of patients who were diagnosed with VTE in the ED and treated with apixaban or warfarin Methods: Adult patients (≥18 years of age) admitted into the ED with a primary discharge diagnosis code indicating VTE were identified from the Premier Hospital database (8/1/2014-5/31/2018). Patients who received apixaban or warfarin during the ED visit were identified and grouped into two study cohorts according to the oral anticoagulant received. Patients treated with warfarin were additionally required to have received ≥1 injectable anticoagulant during ED admissions. The first of such VTE ED admissions was defined as the index event, with the corresponding ED or hospital discharge date as the index date. Patient demographics and clinical and hospital characteristics were evaluated during the index event or a 12-month baseline period. The outcomes of ED discharge status, hospital LOS (ED visit alone has LOS = 0 day), cost of the index event, and rate of 1-month all-cause hospital readmission were compared for the two study cohorts. Multivariable logistic regression analyses were conducted to evaluate the impact of apixaban vs. warfarin treatment on the likelihood of being moved from the ED to the inpatient setting vs. discharged from the ED, as well as the likelihood of 1-month all-cause readmission. Generalized linear models were used to evaluate the impact of apixaban vs. warfarin treatment on index event hospital LOS and cost. Covariates in all analyses included age, gender, race, payer type, Charlson Comorbidity Index score group, baseline bleed status, baseline VTE status, index VTE type, and hospital characteristics. Results: Of the overall study population, 30.5% (n=12,174; mean age: 59.7 years) received apixaban and 69.5% (n=27,767; mean age: 59.3 years) received warfarin for VTE in the ED setting. Mean Charlson Comorbidity Index score was lower for apixaban vs. warfarin treated patients (1.0 vs. 1.3; p<0.001). A significantly lower proportion of patients treated with apixaban, compared with those treated with warfarin, were admitted to the inpatient setting (31.0% vs. 67.1%, p<0.001). Unadjusted mean hospital LOS was shorter (0.9 vs. 2.6 days per patient; p<0.001) and mean index event cost lower ($2,389 vs. $5,348 per patient; p<0.001) for apixaban vs. warfarin patients. The unadjusted rate of 1-month all-cause readmission was also lower for apixaban vs. warfarin patients (10.3% vs. 12.4%; p<0.001). After adjusting for patient and hospital characteristics, apixaban treatment was associated with a significantly lower likelihood of admission to the inpatient setting vs. warfarin (Odds Ratio [OR]: 0.124, 95% Confidence Interval [CI]: 0.115 to 0.133; p<0.001). Correspondingly, mean index hospital LOS was 1.42 days shorter (95% CI: -1.47 to -1.36; p<0.001) and mean index event cost per patient was significantly lower ($3,732 [95% CI: $3,565 to $3,907] vs. $8,008 [95% CI: $7,676 to $8,355]; difference: -$4,276; p<0.001). After taking into account patient and hospital characteristics, the likelihood of all-cause 1-month readmission was significantly lower for patients treated with apixaban vs. warfarin (OR: 0.853, 95% CI: 0.793 to 0.917; p<0.001). Conclusions: In the real-world setting, VTE patients admitted into the ED who are treated with apixaban had a lower likelihood than warfarin treated patients of being subsequently admitted into the inpatient setting, which was reflected in shorter average LOS and lower average index event cost. The risk of 1-month all-cause readmission was also lower for patients treated with apixaban vs. warfarin. Disclosures Deitelzweig: Pfizer: Consultancy; Bristol-Myers Squibb: Consultancy. Hlavacek:Pfizer Inc.: Employment. Mardekian:Pfizer Inc.: Employment. Rosenblatt:Bristol-Myers Squibb: Other: Stock Owner ; Bristol-Myers Squibb Company: Employment. Russ:Pfizer: Employment. Tuell:Bristol-Myers Squibb: Employment. Lingohr-Smith:Novosys Health: Employment. Lin:Pfizer: Consultancy; Novosys Health: Employment; Bristol-Myers Squibb: Consultancy. Guo:Bristol-Myers Squibb: Employment.

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FORMATION OF FORECAST ON THE INFLATION LEVEL IN SFD TAKING INTO ACCOUNT DYNAMICS OF DEVELOPMENT OF REGIONAL ECONOMY

Scientific Bulletin: finance, banking, investment. ◽

10.37279/2312-5330-2020-2-223-231 ◽

2020 ◽

pp. 223-231

Author(s):

Olga S. Sivash ◽

Roman S. Usenko

Keyword(s):

Russian Federation ◽

Inflation Rate ◽

Negative Impact ◽

Statistical Significance ◽

Pair Correlation ◽

Federal District ◽

Statistical Dependence ◽

Factors Affecting ◽

The Russian Federation ◽

The Impact

Inflation is a complex multilateral process, which, in general, has a negative impact on the economy, reduces the level of economic activity of the population and leads to a decrease in the level of real income. The article studies the main constituent elements of the inflation category, reveals the parameters of the impact on the economy of the inflation process, studies the dynamics of factors affecting the forecast inflation rate in the Southern Federal District, develops a regional multifactor inflation model, and based on the approximated data, a forecast of the annual inflation rate is constructed in the Southern Federal District at the end of 2020. The most significant factors affecting the inflation rate in the Russian Federation were identified from the position of the direction of their influence: acceleration or deceleration of inflation, as well as from the point of view of their degree of influence on the inflation rate. At the same time, the influence of the coronavirus pandemic and fluctuations in the oil market on the economic parameters in the Russian Federation in 2020, on the price level of individual food and non-food products was examined. The analyzed indicator of the inflation rate is defined as an indicator of the state of the economic situation in the country, it is revealed that this variable will be dependent. Using the methods of correlation and regression analysis, a mathematical expression is found in the form of a regression model and its adequacy and statistical significance are evaluated. The coefficient of pair correlation, which characterizes the degree of statistical dependence between two variables, without taking into account the influence of other variables, was adopted as the main indicator characterizing the relationship between the analyzed variables. As a result of the calculations, a model of multiple linear regression of the inflation rate was built, the average monthly nominal accrued wages of the employees of the organizations were approximated, and approximation equations were obtained, which made it possible to build an inflation rate forecast for the Southern Federal District for 2019-2020.

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Impact of Delayed Admission to the Intensive Care Unit from the Emergency Department upon Sepsis Outcomes and Sepsis Protocol Compliance

Critical Care Research and Practice ◽

10.1155/2017/9616545 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Michael Agustin ◽

Lori Lyn Price ◽

Augustine Andoh-Duku ◽

Peter LaCamera

Keyword(s):

Emergency Department ◽

Hospital Mortality ◽

Statistical Significance ◽

Tertiary Care ◽

Included Study ◽

Chi Square ◽

Significant Difference ◽

Protocol Compliance ◽

Sepsis And Septic Shock ◽

The Impact

Rationale. The impact of emergency department length of stay (EDLOS) upon sepsis outcomes needs clarification. We sought to better understand the relationship between EDLOS and both outcomes and protocol compliance in sepsis. Methods. We performed a retrospective observational study of septic patients admitted to the ICU from the ED between January 2012 and December 2015 in a single tertiary care teaching hospital. 287 patients with severe sepsis and septic shock were included. Study population was divided into patients with EDLOS < 6 hrs (early admission) versus ≥6 hours (delayed admission). We assessed the impact of EDLOS on hospital mortality, compliance with sepsis protocol, and resuscitation. Statistical significance was determined by chi-square test. Results. Of the 287 septic ED patients, 137 (47%) were admitted to the ICU in <6 hours. There was no significant in-hospital mortality difference between early and delayed admissions (p=0.68). Both groups have similar compliance with the 3-hour protocol (p=0.77). There was no significant difference in achieving optimal resuscitation within 12 hours (p=0.35). Conclusion. We found that clinical outcomes were not significantly different between early and delayed ICU admissions. Additionally, EDLOS did not impact compliance with the sepsis protocol with the exception of repeat lactate draw.

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The Influence and Significance of Financial Ratios on Firm Profitability: Evidence from the Listed Banks on Iraqi Stock Exchange

Webology ◽

10.14704/web/v18si04/web18123 ◽

2021 ◽

Vol 18 (Special Issue 04) ◽

pp. 206-228

Author(s):

Ali Naser Thabet ◽

Maysoon Dawood Hussein ◽

Emad Kendory

Keyword(s):

Factor Analysis ◽

Negative Impact ◽

Positive Impact ◽

Stock Exchange ◽

Statistical Significance ◽

Ratio Analysis ◽

Financial Ratio ◽

Financial Ratio Analysis ◽

Firm Profitability ◽

The Impact

This study aims to assess the impact of the ratios on companies profitability through examination examination of the data from an Iraqi exchange (ISE) sample of banks for the 2007-2015 period. Sample data was analyzed following the multiple regression model and factor analysis, to explore the statistical significance of relationships between firm profitability and the components of financial ratio analysis. Empirical findings of the study indicate that financial ratio analysis variables of Earnings per share (ID), Interest Repetition (IR) and Current Ratio (TR), which are directly related to return on Assets (ROA), have a significantly positive impact on firm profitability of listed banks in ISE. The study also reveals that the Book Value per share (BV), another component of the independent variable, has a significant but negative impact on firm profitability. In addition, the factor analysis further reveals that, relative to the other variables, ID, BV and ROA represents the most important variables applied in this study.

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Impact of electronic personal health record use on engagement and intermediate health outcomes among cardiac patients: a quasi-experimental study

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocv164 ◽

2016 ◽

Vol 23 (1) ◽

pp. 119-128 ◽

Cited By ~ 27

Author(s):

Tammy Toscos ◽

Carly Daley ◽

Lisa Heral ◽

Riddhi Doshi ◽

Yu-Chieh Chen ◽

...

Keyword(s):

Body Mass Index ◽

Health Outcomes ◽

Body Mass ◽

Patient Engagement ◽

Information Exchange ◽

Personal Health Record ◽

Personal Health ◽

Health Record ◽

Quasi Experimental ◽

The Impact

Abstract Objectives To determine the impact of tethered personal health record (PHR) use on patient engagement and intermediate health outcomes among patients with coronary artery disease (CAD). Methods Adult CAD patients ( N = 200) were enrolled in this prospective, quasi-experimental observational study. Each patient received a PHR account and training on its use. PHRs were populated with information from patient electronic medical records, hosted by a Health Information Exchange. Intermediate health outcomes including blood pressure, body mass index, and hemoglobin A1c (HbA1c) were evaluated through electronic medical record review or laboratory tests. Trends in patient activation measure® (PAM) were determined through three surveys conducted at baseline, 6 and 12 months. Frequency of PHR use data was collected and used to classify participants into groups for analysis: Low , Active , and Super users. Results There was no statistically significant improvement in patient engagement as measured by PAM scores during the study period. HbA1c levels improved significantly in the Active and Super user groups at 6 months; however, no other health outcome measures improved significantly. Higher PAM scores were associated with lower body mass index and lower HbA1c, but there was no association between changes in PAM scores and changes in health outcomes. Use of the PHR health diary increased significantly following PHR education offered at the 6-month study visit and an elective group refresher course. Conclusions The study findings show that PHR use had minimal impact on intermediate health outcomes and no significant impact on patient engagement among CAD patients.

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