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Research ArticleOriginal Research

The Impact of Community Health Information Exchange Usage on Time to Reutilization of Hospital Services

Chantel Sloan-Aagard, Jeffrey Glenn, Juan Nañez, Scott B. Crawford, J. C. Currey and Emily Hartmann
The Annals of Family Medicine January 2023, 21 (1) 19-26; DOI: https://doi.org/10.1370/afm.2903
Chantel Sloan-Aagard
1Paso del Norte Health Information Exchange, El Paso, Texas
2Department of Public Health, Brigham Young University, Provo, Utah
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  • For correspondence: chantel.sloan@byu.edu
Jeffrey Glenn
2Department of Public Health, Brigham Young University, Provo, Utah
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Juan Nañez
1Paso del Norte Health Information Exchange, El Paso, Texas
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Scott B. Crawford
3Department of Emergency Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
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J. C. Currey
1Paso del Norte Health Information Exchange, El Paso, Texas
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Emily Hartmann
1Paso del Norte Health Information Exchange, El Paso, Texas
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    Figure 1.

    Flowchart of cohort and group selection.

    ED = emergency department; ICD-10 = International Statistical Classification of Diseases, 10th Revision; PCP = primary care physician; PHIX = Paso del Norte Health Information Exchange.

    a These codes were excluded because they indicate normal pregnancy or elective termination of pregnancy. For example, patients with false labor were labeled as inpatient in the system. They were expected to return as inpatient for delivery, and thus were excluded.

    b Patients brought to the hospital through the prison system, border control, or other law enforcement agencies could not be reliably followed-up. Also, patients with military insurance are referred out from military hospitals for specific purposes, making them non-representative of the larger population.

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    Figure 2.
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    Figure 2.

    Survival curves for key characteristics by case group (ED or inpatient visit).

    ED = emergency department; F = female; HIE = health information exchange; INP = inpatient; = male; NonHisp = Non-Hispanic; PHIX = Paso del Norte Health Information Exchange.

    Note: Censoring events are shown as crosses and CIs are included except for insurance categories, for ease of viewing. Time (x axis) is in days. Median number of days to second hospital visit for each group are shown in the upper right corner of the plot. If the number of persons re-entering the ED or INP never drops below 50%, the median cannot be calculated.

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    Figure 3.

    Proportion of ICD-10 code groups reported during hospital visits and physician use of HIE.

    ED = emergency department; HIE = health information exchange; ICD-10 = International Statistical Classification of Diseases, 10th Revision.

    Note: Graphic represents the proportion of ICD-10 code groups reported during hospital visits, divided by the first inpatient visit and the second visit (ED or inpatient combined, cases only), and whether the HIE was accessed between the first and second visit by a primary care physician. A similar chart for all variables in the model is included in Supplemental Figure 3.

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    Table 1.

    Cohort Characteristics by HIE Lookup at Post-Discharge Appointment (N = 8,216)

    CharacteristicHIE Lookup
    (n = 270)
    No HIE Lookup
    (n = 7,946)
    P
    Value
    Gender, No. (%).09
       Female151 (56)4,860 (61)
       Male119 (44)3,085 (39)
       NA   0 (0)   1 (0)
    Age, y, No. (%).60
       18-49115 (43)3,245 (41)
       ≥50155 (57)4,701 (59)
    Ethnicity, No. (%)<.001a
       Hispanic153 (57)5,611 (71)
       Non-Hispanic 54 (20)1,083 (14)
       NA 63 (23)1,252 (16)
    Insurance status, No. (%).57
       Medicaid33 (12)1,049 (13)
       Medicare63 (23)1,929 (24)
       Private75 (28)2,368 (30)
       Self-pay52 (19)1,236 (16)
       Uninsured24 (9)705 (9)
       NA23 (9)659 (8)
       Patient days, median, (IQR)108 (11-256)66 (11-169)<.001a
    • HIE = health information exchange; IQR = interquartile range; NA = not available.

    • ↵a Significance level 0.001

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    Table 2.

    Cohort Characteristics by Outcome Group (N = 8,216)

    CharacteristicCase Group 1:
    ED Visit
    (n = 3,809)
    Case Group 2:
    Inpatient Visit
    (n = 2,627)
    Controls: No
    Second Hospital
    Visit (n = 1,780)
    P Value
    Gender, No. (%)<.001b
       Female2,441 (64)1,661 (63) 909 (51)
       Male1,367 (36) 966 (37) 871 (49)
       NA  1 (0)  0 (0)  0 (0)
    Age, y, No. (%)<.001b
       18-491,411 (37)1,111 (42) 838 (47)
       ≥502,398 (63)1,516 (58) 942 (53)
       NA  0 (0)  0 (0)  0 (0)
    Ethnicity, No. (%).003a
       Hispanic2,498 (66)2,005 (76)1,261 (71)
       Non-Hispanic 465 (12) 370 (14) 302 (17)
       NA 846 (22) 252 (10) 217 (12)
    Insurance status, No. (%)<.001b
       Medicaid 509 (13) 368 (14) 205 (12)
       Medicare1,038 (27) 616 (23) 338 (19)
       Private1,095 (29) 831 (32) 517 (29)
       Self-pay 484 (13) 293 (11) 511 (29)
       Uninsured 323 (8) 302 (11) 104 (6)
       NA 360 (9) 217 (8) 105 (6)
    HIE accessed, No. (%)<.001b
       Yes 107 (3)  60 (2) 103 (6)
       No3,702 (97)2,567 (98)1,677 (94)
       Patient days, median (IQR)   43 (10-108)   26 (2-88)  290 (207-343)<.001b
    • ED = emergency department; HIE = health information exchange; IQR = interquartile range; NA = not available.

    • Note: Outcome groups were based on whether a patient visited an ED or was rehospitalized (inpatient visit) for the same or similar symptoms as indicated by the ICD-10 codes from first hospital discharge.

    • ↵a Significance level 0.01

    • ↵b Significance level 0.001

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    Table 3.

    Cox Proportional Hazards Results by Case Group

    CharacteristicCase Group 1: ED Visit (n = 3,809)Case Group 2: Inpatient Visit (n = 2,627)
    CoefficientHR (LCI, UCI)P ValueCoefficientHR (LCI, UCI)P Value
    Gender
       FemaleReferenceReferenceReferenceReferenceReferenceReference
       Male−0.260.77 (0.71, 0.84)<.001c−0.280.75 (0.69, 0.82)<.001c
    Age, y
       18-49ReferenceReferenceReferenceReferenceReferenceReference
       ≥500.171.18 (1.08, 1.3)<.001c0.131.13 (1.02, 1.26).02a
    Ethnicity
       HispanicReferenceReferenceReferenceReferenceReferenceReference
       Non-Hispanic−0.200.82 (0.73, 0.91)<.001c−0.170.84 (0.75, 0.95).004b
    Insurance type
       MedicaidReferenceReferenceReferenceReferenceReferenceReference
       Medicare−0.130.88 (0.76, 1.02).08−0.100.91 (0.77, 1.07).24
       Private−0.220.81 (0.71, 0.91)<.001c−0.170.84 (0.74, 0.96).01a
       Self-pay−0.710.49 (0.43, 0.57)<.001c−0.940.39 (0.33, 0.46)<.001c
       Uninsured0.001 (0.85, 1.17)1.000.041.04 (0.88, 1.23).65
    HIE accessed
       NoReferenceReferenceReferenceReferenceReferenceReference
       Yes−0.530.59 (0.46, 0.76)<.001c−0.590.56 (0.42, 0.74)<.001c
    • ED = emergency department; HIE = health information exchange; HR = hazard ratio; LCI = lower confidence interval; UCI = upper confidence interval.

    • Note: The dependent variables are being rehospitalized (inpatient visit) or having an ED visit after the post-inpatient primary care physician visit. Independent variables are whether the HIE was accessed, insurance category, age, ethnicity, and gender.

    • ↵a Significance level 0.05

    • ↵b Significance level 0.01

    • ↵c Significance level 0.001

Additional Files

  • Figures
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  • SUPPLEMENTAL MATERIALS IN PDF FILE BELOW

    • Sloan.pdf -

      PDF file

  • VISUAL ABSTRACT IN PNG FILE BELOW

    • 21.1_Sloan-Aargard_visualabstract_v06.png -

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Annals of Family Medicine: 21 (1)
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The Impact of Community Health Information Exchange Usage on Time to Reutilization of Hospital Services
Chantel Sloan-Aagard, Jeffrey Glenn, Juan Nañez, Scott B. Crawford, J. C. Currey, Emily Hartmann
The Annals of Family Medicine Jan 2023, 21 (1) 19-26; DOI: 10.1370/afm.2903

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The Impact of Community Health Information Exchange Usage on Time to Reutilization of Hospital Services
Chantel Sloan-Aagard, Jeffrey Glenn, Juan Nañez, Scott B. Crawford, J. C. Currey, Emily Hartmann
The Annals of Family Medicine Jan 2023, 21 (1) 19-26; DOI: 10.1370/afm.2903
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