Study of fragmented care makes 'great case' for IT investment

In a new study of adult care visits, which found that patients are visiting multiple sites for care, researchers reveal the extent to which medical information has become fragmented. Because of the increased risk of medical errors and adverse events this makes a strong case for health IT investment, say its authors.

In the study publishing in the December issue of Archives of Internal Medicine, researchers at Children's Hospital Boston looked at adult acute care in Massachusetts and found that of 3.6 million adults visiting an acute care site during a five-year period, almost a third sought care at two or more different hospitals. These patients accounted for more than half of all acute care visits in the state, as well as more frequent hospitalizations and greater costs.

"We specifically chose to look at the acute care setting because it is there that the patient first interfaces with a healthcare provider, who needs relevant clinical information immediately to make informed decisions," says Fabienne Bourgeois, MD, of Children's Division of General Pediatrics and the study's first author. "The acuity of patients presenting leaves little time for providers to track down relevant clinical information; this is a scenario where an integrated source of health information could be of great value."

In the study, Bourgeois and colleagues Kenneth Mandl, MD, and Karen Olson, PhD, of the Children's Hospital Informatics Program and Division of Emergency Medicine focused on visits from 2002 – 2007 to emergency departments, inpatient units and observation units at 77 nonfederal acute care hospitals and satellite emergency facilities.

Researchers collected data from three databases managed by the state's Division of Health Care Finance and Policy on a quarterly basis, and tracked patients via unique health identification numbers (UHINs) assigned from social security numbers. Of the 3.6 million adult patients visiting an acute care site, 1.1 million (31 percent) visited two or more hospitals during the study period and accounted for 56.5 percent of all acute care visits. The authors also identified a subgroup of 43,794 patients (1 percent) that visited five or more different hospitals, accounting for roughly one-tenth of all acute visits.

"The number of sites that some patients went to for acute care astonished us," says Mandl, senior author on the study. "For the first time we showed just how common it is to go across sites of care, and now understanding this, we can look at the issue of information fragmentation and demonstrate the critical value of making vital health information accessible across settings."

Compared with patients with repeat visits to the same site, the researchers found that patients visiting multiple sites tended to be younger, were more likely to be male, were more frequently hospitalized, incurred higher charges at any one visit, and were more likely to have a primary psychiatric diagnosis listed as the reason for their visit.

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