National Hospital Care Survey Demonstration Projects: Characteristics of Inpatient and Emergency Department Encounters Among Patients With Any Listed Diagnosis of Alzheimer Disease.

Objective-This report demonstrates the use of National Hospital Care Survey (NHCS) data using Alzheimer disease (AD) as an outcome. Inpatient discharges and emergency room encounters among patients with AD are described to demonstrate the use of NHCS. The capability of NHCS to link across hospital settings and to the National Death Index (NDI) is highlighted. The data are unweighted and are not nationally representative. Methods-This study analyzed inpatient (IP) and emergency department (ED) data from the 83 nonchildren's hospitals in the 2014 NHCS, out of a sample of 581 hospitals that provided Uniform Bill (UB)-04 administrative claims data for both the IP and ED settings. Encounters with any listed diagnosis of AD were identified using an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code. Individual patients who had any encounter during calendar year 2014 were linked across different hospital-based settings during the same year and with NDI to identify deaths in 2014 or 2015. Results-Analyses are presented on IP and ED encounters with any listed diagnosis of AD to highlight the analytical capabilities of NHCS not available in previous surveys. New data elements not available in the National Hospital Discharge Survey (NHCS' predecessor survey) are analyzed, including intensive care use, and diagnostic and therapeutic services received. Linkage across hospital settings (IP and ED) allows for differentiation of patients who were admitted directly as inpatients from those who were admitted as inpatients from the ED, and allows for identification of patients with only an ED encounter. Linkage to NDI allows for analyses of the underlying cause of death for those deaths occurring in 2014 and 2015. Although these data are not nationally representative, NHCS provides unique analytical opportunities to examine health care utilization among patients with AD across settings.

State Variation in Electronic Sharing of Information in Physician Offices: United States, 2015.

KEY FINDINGS: Data from the National Electronic Health Records Survey •In 2015, the percentage of physicians who had electronically sent patient health information ranged from 19.4% in Idaho to 56.3% in Arizona. •In 2015, the percentage of physicians who had electronically received patient health information ranged from 23.6% in Louisiana and Mississippi to 65.5% in Wisconsin. •In 2015, the percentage of physicians who had electronically integrated patient health information from other providers ranged from 18.4% in Alaska to 49.3% in Delaware. •In 2015, the percentage of physicians who had electronically searched for patient health information ranged from 15.1% in the District of Columbia to 61.2% in Oregon. The Health Information Technology for Economic and Clinical Health Act (HITECH) provides financial incentives to eligible providers using a certified electronic health record (EHR) system (1,2). In 2015, 77.9% of office-based physicians had a certified EHR system, up from 74.1% in 2014 (3-5). A federal plan to enhance the nation's health information technology infrastructure was published in 2015 to support information sharing (6,7). Therefore, this report uses the 2015 National Electronic Health Records Survey (NEHRS) to describe the extent to which physicians can electronically send, receive, integrate, and search for patient health information.

The role of health IT and delivery system reform in facilitating advanced care delivery.

OBJECTIVES: To examine whether physicians using health information technology and participating in new models of payment and delivery were more likely to perform care processes associated with improved care delivery. STUDY DESIGN: Nationally representative, cross-sectional data on US office-based physicians from the 2012 National Ambulatory Medical Care Survey Physician Workflow Survey. METHODS: Multivariate regression analysis of whether physicians routinely performed 14 specific care processes in 4 categories: population management, quality measurement, patient communication, and care coordination. Key independent measures were electronic health record (EHR) use and accountable care organization (ACO) or patient-centered medical home (PCMH) participation. RESULTS: A majority of physicians reported routinely conduct at least 1 care process related to care coordination (89%), patient communication (69%), and population management (67%); less than half reported performing at least 1 quality measurement process routinely (44%). EHR use and ACO or PCMH participation were independently associated with a higher likelihood of performing care processes. Physicians who were using EHRs in combination with participation in ACO or PCMH initiatives had the highest likelihood of routinely performing the care processes: physicians who used an EHR and participated in ACO or PCMH initiatives were between 6 and 22 percentage points more likely to routinely perform the care processes than physicians with EHRs alone. CONCLUSIONS: In 2012, physicians using EHRs and participating in ACO or PCMH initiatives were more likely than other physicians to be routinely engaging in care processes expected to improve healthcare outcomes. Yet, many US physicians were not performing these processes routinely. This analysis highlights several specific areas where more work is necessary to facilitate wider adoption of these activities.

Adoption of Certified Electronic Health Record Systems and Electronic Information Sharing in Physician Offices: United States, 2013 and 2014.

KEY FINDINGS: Data from the 2014 National Electronic Health Records Survey. In 2014, 74.1% of office-based physicians had a certified electronic health record (EHR) system, up from 67.5% in 2013. The percentage of physicians who had a certified EHR system ranged from 58.8% in Alaska to 88.6% in Minnesota. In 2014, 32.5% of office-based physicians with a certified EHR system were electronically sharing patient health information with external providers. The percentage of physicians with a certified EHR system electronically sharing patient health information with external providers ranged from 17.7% in New Jersey to 58.8% in North Dakota.

Acceptance of new patients with public and private insurance by office-based physicians: United States, 2013.

Physician acceptance of new Medicaid patients has shown to be lower than acceptance of new Medicare patients or new privately insured patients. Acceptance of new Medicaid patients also has shown to be lower in states with lower Medicaid payment rates to physicians. Using the 2013 National Electronic Health Records Survey (NEHRS), this report summarizes physician acceptance of new patients with Medicaid, Medicare, and private insurance. It also summarizes information on how these acceptance rates vary by select physician characteristics and by state.

Progress with electronic health record adoption among emergency and outpatient departments: United States, 2006-2011.

The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 provides incentive payments to eligible hospitals and providers that demonstrate the meaningful use of a certified electronic health record (EHR) system . This report describes the adoption of EHRs in hospital emergency departments (EDs) and outpatient departments (OPDs) from 2006 through 2011 using the National Hospital Ambulatory Medical Care Survey (NHAMCS).

Clinical benefits of electronic health record use: national findings.

OBJECTIVE: To assess whether physicians' reported electronic health record (EHR) use provides clinical benefits and whether benefits depend on using an EHR meeting Meaningful Use criteria or length of EHR experience. DATA SOURCE: The 2011 Physician Workflow study, representative of U.S. office-based physicians. STUDY DESIGN: Cross-sectional data were used to examine the association of EHR use with enhanced patient care overall and nine specific clinical benefits. PRINCIPAL FINDINGS: Most physicians with EHRs reported EHR use enhanced patient care overall (78 percent), helped them access a patient's chart remotely (81 percent), and alerted them to a potential medication error (65 percent) and critical lab values (62 percent). Between 30 and 50 percent of physicians reported that EHR use was associated with clinical benefits related to providing recommended care, ordering appropriate tests, and facilitating patient communication. Using EHRs that met Meaningful Use criteria and having 2 or more years of EHR experience were independently associated with reported benefits. Physicians with EHRs meeting Meaningful Use criteria and longer EHR experience were most likely to report benefits across all 10 measures. CONCLUSIONS: Physicians reported EHR use enhanced patient care overall. Clinical benefits were most likely to be reported by physicians using EHRs meeting Meaningful Use criteria and longer EHR experience.

EHR adopters vs. non-adopters: Impacts of, barriers to, and federal initiatives for EHR adoption.

While adoption of electronic health record (EHR) systems has grown rapidly, little is known about physicians' perspectives on its adoption and use. Nationally representative survey data from 2011 are used to compare the perspectives of physicians who have adopted EHRs with those that have yet to do so across three key areas: the impact of EHRs on clinical care, practice efficiency and operations; barriers to EHR adoption; and factors that influence physicians to adopt EHRs. Despite significant differences in perspectives between adopters and non-adopters, the majority of physicians perceive that EHR use yields overall clinical benefits, more efficient practices and financial benefits. Purchase cost and productivity loss are the greatest barriers to EHR adoption among both adopters and non-adopters; although non-adopters have significantly higher rates of reporting these as barriers. Financial incentives and penalties, technical assistance, and the capability for electronic health information exchange are factors with the greatest influence on EHR adoption among all physicians. However, a substantially higher proportion of non-adopters regard various national health IT policies, and in particular, financial incentives or penalties as a major influence in their decision to adopt an EHR system. Contrasting these perspectives provides a window into how national policies have shaped adoption thus far; and how these policies may shape adoption in the near future.

Determining Sufficient Number of Imputations Using Variance of Imputation Variances: Data from 2012 NAMCS Physician Workflow Mail Survey.

How many imputations are sufficient in multiple imputations? The answer given by different researchers varies from as few as 2 - 3 to as many as hundreds. Perhaps no single number of imputations would fit all situations. In this study, η, the minimally sufficient number of imputations, was determined based on the relationship between m, the number of imputations, and ω, the standard error of imputation variances using the 2012 National Ambulatory Medical Care Survey (NAMCS) Physician Workflow mail survey. Five variables of various value ranges, variances, and missing data percentages were tested. For all variables tested, ω decreased as m increased. The m value above which the cost of further increase in m would outweigh the benefit of reducing ω was recognized as the η. This method has a potential to be used by anyone to determine η that fits his or her own data situation.

Physician experience with electronic health record systems that meet meaningful use criteria: NAMCS physician workflow survey, 2011.

KEY FINDINGS: Data from the National Ambulatory Medical Care Survey's (NAMCS) Physician Workflow Survey, 2011. About three-quarters of physicians with electronic health record (EHR) systems have systems that meet meaningful use criteria. Physicians with EHR systems that meet meaningful use criteria were more likely to report that their system provides time savings than physicians with systems not meeting meaningful use criteria, but only in some areas. Physicians with EHR systems that meet meaningful use criteria were more likely to report enhanced confidentiality and less disruption in their interactions with patients than physicians with systems not meeting meaningful use criteria. Physicians with EHR systems that meet meaningful use criteria were no more likely to report financial benefits and selected clinical benefits than those with systems not meeting meaningful use criteria.

Variation in electronic health record adoption and readiness for meaningful use: 2008-2011.

BACKGROUND: Federal initiatives are underway that provide physicians with financial incentives for meaningful use (MU) of electronic health records (EHRs) and assistance to purchase and implement EHRs. OBJECTIVE: We sought to examine readiness and interest in MU among primary care physicians and specialists, and identify factors that may affect their readiness to obtain MU incentives. DESIGN/PARTICIPANTS: We analyzed 4 years of data (2008-2011) from the National Ambulatory Medical Care Survey (NAMCS) Electronic Medical Record (EMR) Supplement, an annual cross-sectional nationally representative survey of non-federally employed office-based physicians. MAIN MEASURES: Survey-weighted EHR adoption rates, potential to meet selected MU criteria, and self-reported intention to apply for MU incentives. We also examined the association between physician and practice characteristics and readiness for MU. KEY RESULTS: The overall sample consisted of 10,889 respondents, with weighted response rates of 62 % (2008); 74 % (2009); 66 % (2010); and 61 % (2011). Primary care physicians' adoption of EHRs with the potential to meet MU nearly doubled from 2009 to 2011 (18 % to 38 %, p<0.01), and was significantly higher than specialists (19 %) in 2011 (p<0.01). In 2011, half of physicians (52 %) expressed their intention to apply for MU incentives; this did not vary by specialty. Multivariate analyses report that EHR adoption was significantly higher in both 2010 and 2011 compared to 2009, and primary care physicians and physicians working in larger or multi-specialty practices or for HMOs were more likely to adopt EHRs with the potential to meet MU. CONCLUSIONS: Physician EHR adoption rates increased in advance of MU incentive payments. Although interest in MU incentives did not vary by specialty, primary care physicians had significantly higher rates of adopting EHRs with the potential to meet MU. Addressing barriers to EHR adoption, which may vary by specialty, will be important to enhancing coordination of care.

Adoption and use of electronic health records and mobile technology by home health and hospice care agencies.

OBJECTIVE: This report presents national estimates on the adoption and use of electronic health records and mobile technology by home health and hospice care agencies, as well as the agency characteristics associated with adoption. METHODS: Estimates are based on data from the 2007 National Home and Hospice Care Survey, conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. RESULTS: In 2007, 28% of home health and hospice care agencies adopted both electronic health records and mobile technology, while slightly over half (54%) adopted neither. Sixteen percent of agencies adopted only electronic health records. Adoption of both technologies was associated with number of patients served and agency type. Agencies that were for-profit or were jointly owned with a hospital were more likely to have adopted neither technology. Among agencies with electronic health records, the most commonly used functionalities were patient demographics and clinical notes. Among agencies with mobile technology, functionalities for the Outcome and Assessment Information Set (OASIS), e-mail, and appointment scheduling were the most commonly used. Similar percentages of agencies with electronic health records or mobile technology used clinical decision support systems, computerized physician order entry, electronic reminders for tests, and viewing of test results.

Physician adoption of electronic health record systems: United States, 2011.

Data from the 2011 Physician Workflow study In 2011, 55% of physicians had adopted an electronic health record (EHR) system. About three-quarters of physicians who have adopted an EHR system reported that their system meets federal "meaningful use" criteria. Eighty-five percent of physicians who have adopted an EHR system reported being somewhat (47%) or very (38%) satisfied with their system. About three-quarters of adopters reported that using their EHR system resulted in enhanced patient care. Nearly one-half of physicians currently without an EHR system plan to purchase or use one already purchased within the next year.

Physicians in nonprimary care and small practices and those age 55 and older lag in adopting electronic health record systems.

By 2011 more than half of all office-based physicians were using electronic health record systems, but only about one-third of those physicians had systems with basic features such as the abilities to record information on patient demographics, view laboratory and imaging results, maintain problem lists, compile clinical notes, or manage computerized prescription ordering. Basic features are considered important to realize the potential of these systems to improve health care. We found that although trends in adoption of electronic health record systems across geographic regions converged from 2002 through 2011, adoption continued to lag for non-primary care specialists, physicians age fifty-five and older, and physicians in small (1-2 providers) and physician-owned practices. Federal policies are specifically aimed at encouraging primary care providers and small practices to achieve widespread use of electronic health records. To achieve their nationwide adoption, federal policies may also have to focus on encouraging adoption among non-primary care specialists, as well as addressing persistent gaps in the use of electronic record systems by practice size, physician age, and ownership status.

The relationship among child weight status, psychosocial functioning, and pediatric health care expenditures in a medicaid population.

OBJECTIVES: To examine the association between weight status and health service use, while considering the influence of psychosocial functioning and demographic variables. METHODS: Two hundred child-parent dyads were recruited from pediatric primary care clinics and completed measures of height, weight, and questionnaires assessing psychosocial functioning. Claims and expenditure data over a 12-month retrospective period were extracted from the Medicaid claims database. RESULTS: Children who were obese incurred greater health service use and expenditures than children who were of a healthy weight, even after controlling for psychosocial functioning and other demographic variables. Children who were overweight (but not obese) did not have differing levels of claims or expenditures than their healthy weight peers. CONCLUSIONS: Understanding the impact of pediatric obesity on long-term expenditures is critical. These results provide some indication of the financial savings that might be achieved if obese children were supported to achieve a healthier weight status.

Age at disability onset and self-reported health status.

BACKGROUND: The critical importance of improving the well-being of people with disabilities is highlighted in many national health plans. Self-reported health status is reduced both with age and among people with disabilities. Because both factors are related to health status and the influence of the age at disability onset on health status is unclear, we examined the relationship between disability onset and health status. METHODS: The U.S. 1998-2000 Behavioral Risk Factor Surveillance system (BRFSS) provided data on 11,905 adults with disability. Bivariate logistic regression analysis modeled the relationship between age at disability onset (based on self-report of duration of disability) and fair/poor self-perceived health status, adjusting for confounding variables. RESULTS: Key variables included demographics and other measures related to disability and general health status. Disability onset after 21 years of age showed significant association with greater prevalence of fair/poor health compared to early disability onset, even adjusting for current age and other demographic covariates. Compared with younger onset, the adjusted odds ratios (OR) were ages 22-44: OR 1.52, ages 45-64: OR 1.67, and age > or =65: OR 1.53. CONCLUSION: This cross-sectional study provides population-level, generalizable evidence of increased fair or poor health in people with later onset disability compared to those with disability onset prior to the age of 21 years. This finding suggests that examining the general health of people with and those without disabilities might mask differences associated with onset, potentially relating to differences in experience and self-perception. Future research relating to global health status and disability should consider incorporating age at disability onset. In addition, research should examine possible differences in the relationship between age at onset and self-reported health within specific impairment groups.

The effect of caregiving on preventive care for people with disabilities.

BACKGROUND: overall, disparities exist in preventive health care services for people with disabilities compared with other Americans. Little is known about the effects of caregiving on preventive services use. This study examines caregiver characteristics and influence on the use of preventive services for people with disabilities. METHODS: the 2000-2001 Behavioral Risk Factor Surveillance System of 25 states included 5486 self-reported respondents with disabilities who were surveyed for preventive care use. Multivariate logistic regression adjusted for demographic and functional status of these respondents. RESULTS: among the subset of the respondents with caregivers, those with paid caregivers were significantly more likely to receive an influenza vaccination (adjusted odds ratio [OR], 1.49; 95% confidence interval [CI], 1.08-1.93). Among those with a caregiver, those with a spouse/partner caregiver were also significantly more likely to receive an influenza vaccination (adjusted OR, 1.33; 95% CI, 1.05-1.69) or PPV (adjusted OR, 1.59; 95% CI, 1.41-2.38) compared with those with "other" as their caregiver. Women with disabilities with a spouse/partner caregiver were significantly more likely to have ever had a Pap test (adjusted OR, 3.13; 95% CI, 1.41-6.67) or mammogram (adjusted OR, 1.85; 95% CI, 1.23-2.70) than those with "other" relative caregiver. Those respondents who reported "rarely adequate" caregiver satisfaction were significantly more likely to have self-reported ever having colon cancer screening compared with those with a usually adequate caregiver. The majority of results did not show consistent evidence of caregiver benefit, and a fair number of the associations were not statistically significant. CONCLUSION: the findings suggest that having a caregiver is not consistently associated with self-report of ever using preventive services. However, this study suggests that caregiver characteristics are associated with preventive care for people with disabilities. For influenza vaccination, our results showed that paid caregivers were more likely to provide preventive care to individuals with disability than a spouse or partner, which were more likely to provide more preventive care than those with "other" caregiver. Given the number of comparisons, we consider these results to be preliminary and require more confirmation in other population data.