Electronic sharing of diagnostic information and patient outcomes.

OBJECTIVES: Hospital sharing of electronic health record (EHR) diagnostic data has the potential to improve communication across providers and improve patient outcomes. However, implementing EHR systems can be difficult for hospitals. This study uses Hospital Compare (HC) and American Hospital Association (AHA) Annual Information Technology Survey data to estimate the association between sharing EHR data and patient outcomes. STUDY DESIGN: Descriptive and multivariate linear regression analyses. METHODS: This study links 2 years of HC data on 30-day patient mortality and readmissions for heart failure (HF) and pneumonia with 2 years of AHA data. The sample was restricted to hospitals included in both years in both sets of data. We estimated the associations between sharing EHR diagnostic data and patient outcomes with a multivariate linear regression analysis. Results were adjusted by hospital characteristics from the AHA annual survey. RESULTS: Hospitals' sharing of radiology report data with hospitals within their system was associated with significantly lower mortality scores for pneumonia (-0.22; P <.01). Conversely, hospital sharing of radiology report data with hospitals outside their system was associated with significantly higher HF mortality scores (0.26; P <.01). We found qualitatively similar results with sharing laboratory results through EHRs. CONCLUSIONS: Hospital sharing of EHR data with providers within their system is associated with better patient mortality, whereas sharing data with providers outside their system is associated with worsened patient mortality. Improving communication between hospitals using different EHR systems may be more crucial than simply expanding data sharing.

The Impact of State Tort Reforms on Imaging Utilization.

PURPOSE: Defensive medicine, broadly defined as medical practices that protect physicians from malpractice lawsuits without providing benefits to patients, can lead to wasteful use of health care resources and higher cost. Although physicians cite malpractice liability as an important factor driving their decisions to order imaging tests, little research has been done to examine the systematic impact of liability pressure on overall imaging. The authors examined the extent to which radiography use is influenced by malpractice liability pressure among office-based physicians. METHODS: Using National Ambulatory Medical Care Survey data from 1999 to 2010, the authors used multivariate difference-in-difference logistic regression to examine the effects of different types of state tort reforms on the probability of radiography orders by primary care physicians (PCPs) and specialists. RESULTS: The probability that a PCP ordered radiography decreased when states enacted permanent caps on noneconomic damages (-1.0%, P < .01), periodic payment reforms (-1.6%, P < .05), and the total number of tort reforms (-0.5%, P < .05). Specialist physicians were responsive to two reforms: caps on punitive damages (-6.1%, P < .01) and the total number of medical tort laws (-1.2%, P < .01). The passage of new indirect reforms was found to reduce radiography orders for PCPs (-1.8%, P < .05), and the repeal of indirect reforms was found to increase radiography orders for specialists (+3.4%, P < .01). CONCLUSIONS: State tort reform seems to reduce physicians' ordering of radiography. This analysis also suggests that reforms that make it harder to sue physicians have a stronger impact than reforms that directly reduce physicians' malpractice claim payments.

The Impact of Hospital Characteristics on the Availability of Radiology Services at Critical Access Hospitals.

PURPOSE: Although all critical access hospitals (CAHs) provide basic medical and radiographic imaging services, it remains unclear how CAHs provide additional imaging services given relatively low patient volumes and high resource costs. The aim of this study was to examine whether CAHs with more resources or access to resources through affiliation with larger systems are more likely to offer other imaging services in their communities. METHODS: Linking data from the American Hospital Association's annual hospital surveys and the American Hospital Directory's annual surveys from 2009 to 2011, multivariate logistic regressions were performed to estimate the likelihood of individual CAHs with greater financial resources or network affiliations providing specific imaging services (MRI, CT, ultrasound, mammography, and PET/CT), while adjusting for the number of beds, personnel, inpatient revenue share, case mix, rural status, year, and geographic location. RESULTS: Hospital total expenditures were positively associated with the provision of MRI (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.07-1.19), mammography (OR, 1.11; 95% CI, 1.01-1.16), and PET/CT (OR, 1.04; 95% CI, 1.01-1.06). Network affiliation was positively associated with the availability of MRI (OR, 1.75; 95% CI, 1.27-2.39), CT (OR, 2.17; 95% CI, 1.15-4.09), ultrasound (OR, 2.03; 95% CI, 1.17-3.52), and mammography (OR, 2.00; 95% CI, 1.47-2.71). Rural location was negatively associated with the availability of PET/CT (OR, 0.65; 95% CI, 0.49-0.88). CONCLUSIONS: Total hospital expenditures and network participation are important determinants of whether CAHs provide certain imaging services. Encouraging CAHs' participation in larger systems or networks may facilitate access to highly specialized services in rural and underserved areas.

Identifying Patients With Undiagnosed Chronic Conditions: An Examination of Patient Costs Before Chronic Disease Diagnosis.

PURPOSE: Identifying chronic conditions at earlier stages could produce dramatic savings to the health care system. This study sought to determine whether patients with chronic conditions experienced higher medical costs and imaging costs than patients with nonchronic conditions before the onset of chronic disease. METHODS: This retrospective study linked 2004-2012 Medicare Chronic Conditions Warehouse data to Medicare fee-for-service claims data, to examine whether elderly patients that have chronic conditions experienced higher overall medical costs, imaging costs, and imaging share of costs before their diagnosis, compared with patients who have nonchronic conditions, during the same period. Student's t tests were conducted comparing the mean annual costs and imaging share for patients with chronic conditions and patients with nonchronic conditions, for the six years before their diagnosis and two years afterward. RESULTS: Imaging costs for patients with chronic conditions were 9 times higher (P < .001) for 6 years before they were diagnosed with a chronic condition; overall medical costs were 18 times (P < .001) higher than those for patients with nonchronic conditions. A significant (P < .001) but small difference was found between the mean imaging share for patients with, versus without, a chronic condition, up until two years before diagnosis, at which point overall medical costs, imaging costs, and imaging share dramatically increased. CONCLUSIONS: Overall medical costs and imaging costs for patients with chronic conditions are significantly and substantially higher than those for patients with nonchronic conditions for many years before they are diagnosed with chronic conditions. Tracking health care expenditures may identify patients with chronic conditions sooner, potentially producing large savings within the health care system.