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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
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1 to 25 of 50 Research Studies DisplayedNorton JM, Ip A, Ruggiano N
Assessing progress toward the vision of a comprehensive, shared electronic care plan: scoping review.
People with multiple chronic conditions often receive care from a broad array of clinicians across multiple health care settings, making it difficult to share care plans between those facilities and providers. One method for possibly improving care for those individuals is through the development and use of comprehensive, shared, electronic care (e-care) plans. The purpose of the study was to review existing e-care plans and related initiatives that could be utilized to develop a comprehensive, shared e-care plan, and facilitate the National Institutes of Health and Agency for Healthcare Research and Quality joint initiative’s creation of e-care planning tools for people with multiple chronic conditions. The researchers conducted a review of literature from 2015-2020, as well as interviews of expert informants to identify information missing from the literature search. The study identified 7 different interventions for e-care plans and 3 different projects for health care data standards, all of which included elements which could be utilized to further the goals of developing a comprehensive, shared e-care plan. The study concluded that while none of the existing interventions met all the optimal e-care plan criteria for people with multiple chronic conditions, each plan included the infrastructure necessary to progress toward that goal. The researchers reported that gaps must first be addressed, but that a comprehensive, shared e-care plan can improve care coordination across multiple care settings and clinicians.
AHRQ-authored.
Citation: Norton JM, Ip A, Ruggiano N .
Assessing progress toward the vision of a comprehensive, shared electronic care plan: scoping review.
J Med Internet Res 2022 Jun 10;24(6):e36569. doi: 10.2196/36569..
Keywords: Chronic Conditions, Care Coordination, Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare Delivery, Health Information Exchange (HIE)
Cross DA, Stevens MA, Spivack SB
Survey of information exchange and advanced use of other health information technology in primary care settings: capabilities in and outside of the safety net.
This study’s aim was to estimate advanced use of health information technology (health IT) use in safety net versus nonsafety net primary care practices. The authors explored domains of patient engagement, population health management, and electronic information exchange. They examined organizational characteristics that may differently predict advanced use of IT across these settings. A cross-sectional analysis of a national survey of 1776 physician practices was conducted. Health IT use was found to be common across primary care practices, but advanced use of health IT functionalities ranged from only 30% to 50% use. A lag was found for advanced feature use with safety net practices. However, safety net practices who were members of a health system or practice network had comparable health IT capabilities to those in nonsafety net sites.
AHRQ-funded; HS024075.
Citation: Cross DA, Stevens MA, Spivack SB .
Survey of information exchange and advanced use of other health information technology in primary care settings: capabilities in and outside of the safety net.
Med Care 2022 Feb;60(2):140-48. doi: 10.1097/mlr.0000000000001673.
AHRQ-funded; HS024075..
AHRQ-funded; HS024075..
Keywords: Health Information Exchange (HIE), Health Information Technology (HIT), Primary Care
Apathy NC, Holmgren AJ, Werner RM
Growth in health information exchange with ACO market penetration.
This study’s objectives were to assess whether hospitals expand the network breadth of their health information exchange (HIE) partners after joining an accountable care organization (ACO) and to analyze whether this HIE network expansion effect varies across markets with differing levels of ACO penetration. The authors used data from the American Hospital Association Annual Survey and Information Technology Supplement to measure nonfederal acute care hospitals from 2014-2017. There was a 30.7% increase in HIE breadth for 0.35 partner types with ACO participation. This effect was larger for hospitals in high-ACO penetration markets (32% increase) and smaller for hospitals in low-ACO penetration markets (24.8% increase).
AHRQ-funded; HS026116.
Citation: Apathy NC, Holmgren AJ, Werner RM .
Growth in health information exchange with ACO market penetration.
Am J Manag Care 2022 Jan;28(1):e7-e13. doi: 10.37765/ajmc.2022.88815..
Keywords: Health Information Exchange (HIE), Electronic Health Records (EHRs), Health Information Technology (HIT)
Vest JR, Freedman S, Unruh MA
Strategic use of health information exchange and market share, payer mix, and operating margins.
The purpose of this study was to identify the impact of hospitals' use of Health information exchange (HIE) capabilities on outcomes that may be sensitive to changes in different contracting arrangements and referral patterns occurring as a result of improved connectivity. The researchers utilized a panel of community hospitals in nine states and explored the relationship between the number of different data types the hospital could exchange via HIE and changes in market share, payer mix, and operating margin. The study found that an increase in HIE capability was related with a 13% increase in a hospital's discharges that were covered by commercial insurers or Medicare. Increasing intraorganizational sharing of information was related with a 9.6% decrease in the percentage of discharges covered by commercial insurers or Medicare. There was no relationship between increasing HIE capability or intraorganizational information sharing and increased market share or operating margin. CONCLUSIONS: Improving information sharing with external organizations may be an approach to support strategic business goals. PRACTICE IMPLICATIONS: Organizations may be served by identifying ways to leverage HIE instead of focusing on intraorganizational exchange capabilities.
AHRQ-funded; HS024717.
Citation: Vest JR, Freedman S, Unruh MA .
Strategic use of health information exchange and market share, payer mix, and operating margins.
Health Care Manage Rev 2022 Jan-Mar; 47(1):28-36. doi: 10.1097/hmr.0000000000000293..
Keywords: Health Information Exchange (HIE), Health Information Technology (HIT), Electronic Health Records (EHRs)
Pylypchuk Y, Meyerhoefer CD, Encinosa W
The role of electronic health record developers in hospital patient sharing.
This study’s objective was to determine whether hospital adoption of a new electronic health record (EHR) developer increases patient sharing with hospitals using the same developer. Data was extracted on patients shared with other hospitals for 2076 US nonfederal acute care hospitals from the 2011 to 2016 CMS Physician Shared Patient Patterns database. The authors calculated the ratio of patients shared with hospitals outside of the focal hospital’s network that use the same EHR developer as the focal hospital. Switching to a new developer increased the ratio of patients shared with other hospitals using the same developer by 4.1-19.3%, depending on model specification. Magnitude of this effect varied by EHR developer and was increasing in developer market share.
AHRQ-authored.
Citation: Pylypchuk Y, Meyerhoefer CD, Encinosa W .
The role of electronic health record developers in hospital patient sharing.
J Am Med Inform Assoc 2022 Jan;29(3):435-42. doi: 10.1093/jamia/ocab263..
Keywords: Electronic Health Records (EHRs), Health Information Exchange (HIE), Health Information Technology (HIT), Hospitals
Pylypchuk Y, Barker W, Encinosa W
Impact of the 2015 Health Information Technology Certification Edition on interoperability among hospitals.
Most nonfederal acute care hospitals use electronic health records (EHRs) certified by the Office of the National Coordinator for Health Information Technology. In 2015, the Office of the National Coordinator for Health Information Technology finalized the 2015 Health IT Certification Edition and adoption by hospitals began in 2016. In this study, the investigators examined the impact of the 2015 Edition on rates of interoperable exchange among nonfederal acute hospitals.
AHRQ-authored.
Citation: Pylypchuk Y, Barker W, Encinosa W .
Impact of the 2015 Health Information Technology Certification Edition on interoperability among hospitals.
J Am Med Inform Assoc 2021 Aug 13;28(9):1866-73. doi: 10.1093/jamia/ocab083..
Keywords: Health Information Exchange (HIE), Health Information Technology (HIT), Hospitals
Dixon BE, Grannis SJ, McAndrews C BE, Grannis SJ, McAndrews C
Leveraging data visualization and a statewide health information exchange to support COVID-19 surveillance and response: application of public health informatics.
Researchers sought to support public health surveillance and response to coronavirus disease 2019 (COVID-19) through rapid development and implementation of novel visualization applications for data amalgamated across sectors. Capitalizing on a statewide health information exchange, in partnership with health system and public health leaders, Regenstrief biomedical informatics experts rapidly developed and deployed informatics tools to support surveillance and response to COVID-19. The authors concluded that the application of public health informatics methods and tools in Indiana holds promise for other states and nations.
AHRQ-funded; HS025502.
Citation: Dixon BE, Grannis SJ, McAndrews C BE, Grannis SJ, McAndrews C .
Leveraging data visualization and a statewide health information exchange to support COVID-19 surveillance and response: application of public health informatics.
J Am Med Inform Assoc 2021 Jul 14;28(7):1363-73. doi: 10.1093/jamia/ocab004..
Keywords: COVID-19, Health Information Exchange (HIE), Health Information Technology (HIT), Public Health
Palen TE, Peterson L, Palen TE
Clinical quality measure exchange is not easy.
The Trial of Aggregate Data Exchange for Maintenance of Certification and Raising Quality was a randomized controlled trial which first had to test whether quality reporting could be a by-product of clinical care. The investigators reported on the initial descriptive study of the capacity for and quality of exchange of whole-panel, standardized quality measures from health systems. They concluded that the secure transfer of standardized, physician-level quality measures from 4 health systems with mature measure processes proved difficult. There were many errors that required human intervention and manual repair, precluding full automation.
AHRQ-funded; HS022583.
Citation: Palen TE, Peterson L, Palen TE .
Clinical quality measure exchange is not easy.
Ann Fam Med 2021 May-Jun;19(3):207-11. doi: 10.1370/afm.2649..
Keywords: Quality Measures, Quality Indicators (QIs), Quality of Care, Health Information Exchange (HIE), Health Information Technology (HIT)
Everson J, Patel V, Adler-Milstein J
Information blocking remains prevalent at the start of 21st Century Cures Act: results from a survey of health information exchange organizations.
This study’s objective was to assess the prevalence of information blocking of patient data by health systems, electronic health record (EHR) vendors, and others prior to enforcement of new rules to prevent this practice. A national survey of health information exchange organizations (HIEs) was conducted. Eighty-four percent of 106 HIEs who met the inclusion criteria responded. The majority (55%) of HIEs reported that EHR vendors routinely engage in information blocking at least some of the time. The most common blocking behavior of EHR vendors was setting unreasonably high prices which was reported by 42% of HIEs. Behavior health systems most common information blocking behavior was refusing to share information, which was routinely observed by 14% of HIEs. Reported levels of vendor information blocking was related to regional competition among vendors and information blocking was more highly concentrated in some geographic regions than others.
AHRQ-funded; HS026395.
Citation: Everson J, Patel V, Adler-Milstein J .
Information blocking remains prevalent at the start of 21st Century Cures Act: results from a survey of health information exchange organizations.
J Am Med Inform Assoc 2021 Mar 18;28(4):727-32. doi: 10.1093/jamia/ocaa323..
Keywords: Health Information Exchange (HIE), Electronic Health Records (EHRs), Health Information Technology (HIT)
Rahurkar S, Vest JR, Finnell JT
Trends in user-initiated health information exchange in the inpatient, outpatient, and emergency settings.
Prior research on health information exchange (HIE) typically measured provider usage through surveys or they summarized the availability of HIE services in a healthcare organization. Few studies utilized user log files. Using HIE access log files, the investigators measured HIE use in real-world clinical settings over a 7-year period (2011-2017). They found that use of HIE increased in inpatient, outpatient, and emergency department (ED) settings.
AHRQ-funded; HS025502.
Citation: Rahurkar S, Vest JR, Finnell JT .
Trends in user-initiated health information exchange in the inpatient, outpatient, and emergency settings.
J Am Med Inform Assoc 2021 Mar;28(3):622-27. doi: 10.1093/jamia/ocaa226..
Keywords: Health Information Exchange (HIE), Electronic Health Records (EHRs), Health Information Technology (HIT)
Wang G, Wignall J, Kinard D
An implementation model for managing cloud-based longitudinal care plans for children with medical complexity.
In this study, the investigators aimed to iteratively refine an implementation model for managing cloud-based longitudinal care plans (LCPs) for children with medical complexity (CMC). They conducted iterative 1-on-1 design sessions with CMC caregivers (ie, parents/legal guardians) and providers between August 2017 and March 2019. The investigators concluded that utilizing the management strategies, described in the article, when implementing cloud-based LCPs had the potential to improve team-based care across settings.
AHRQ-funded; HS024299.
Citation: Wang G, Wignall J, Kinard D .
An implementation model for managing cloud-based longitudinal care plans for children with medical complexity.
J Am Med Inform Assoc 2021 Jan 15;28(1):23-32. doi: 10.1093/jamia/ocaa207..
Keywords: Children/Adolescents, Implementation, Chronic Conditions, Care Management, Care Coordination, Health Information Exchange (HIE), Health Information Technology (HIT), Teams
Cummins MR, Del Fiol G, Crouch BI
Enabling health information exchange at a US poison control center.
This paper discusses the development and implementation of a poison control center (PCC) to participate in a standards-based health information exchange (HIE). This was previously not possible due to software noncompliance with HIE standards, lack of informatics infrastructure, and the need to integrate HIE processes into workflow. The investigators adapted the Health Level Seven Consolidated Clinical Document Architecture (C-CDA) consultation note for the PCC use case. They developed software called SNOWHITE that enables PCC HIE in tandem with a poisoning information center. It was successfully implemented at the Utah PCC starting in February 2017 through October 218.
AHRQ-funded; HS021472.
Citation: Cummins MR, Del Fiol G, Crouch BI .
Enabling health information exchange at a US poison control center.
J Am Med Inform Assoc 2020 Jul;27(7):1000-06. doi: 10.1093/jamia/ocaa055..
Keywords: Health Information Exchange (HIE), Health Information Technology (HIT)
Dixon BE, Zhang Z, Amo JN
Improving notifiable disease case reporting through electronic information exchange-facilitated decision support: a controlled before-and-after trial.
This study examined the results of implementing an electronic, prepopulated notifiable disease report form on case reporting rates by ambulatory care clinics to public health authorities. They conducted a 2-year controlled before-and-after trial of a health information exchange (HIE) in Indiana. Data was analyzed from electronic prepopulated reports and paper and fax reports submitted to a local health department for 7 conditions by using a difference-in-differences model. Provider reporting rates for chlamydia and gonorrhea increased significantly during the baseline period. During the intervention period they decreased significantly in control clinics. Completion and timeliness improved for both intervention and control clinics.
AHRQ-funded; HS020909.
Citation: Dixon BE, Zhang Z, Amo JN .
Improving notifiable disease case reporting through electronic information exchange-facilitated decision support: a controlled before-and-after trial.
Public Health Rep 2020 May/Jun;135(3):401-10. doi: 10.1177/0033354920914318..
Keywords: Health Information Exchange (HIE), Health Information Technology (HIT), Electronic Health Records (EHRs), Public Health, Public Reporting, Ambulatory Care and Surgery
Everson J, Butler E
Hospital adoption of multiple health information exchange approaches and information accessibility.
The aim of this study was to determine the change in adoption of 3 types of electronic health information exchange (HIE) in hospitals for 3 types of information exchange: secure messaging, provider portals, and use of an HIE; and to assess if growth in each approach corresponded to an increased ability to access and integrate patient information from outside providers. A sample of 1917 hospitals that responded to the American Hospital Association Information Technology Supplement every year from 2014 to 2016 was used for the analysis. Adoption of each approach increased by 9-15 percentage points over that time. The average number of HIE approaches increased from 1.0 to 1.4. The likelihood of having outside information increased by 10.3 percentage points with adoption of 1 approach, and by 9.5 percentage points with adoption of a second approach.
AHRQ-funded; HS026395.
Citation: Everson J, Butler E .
Hospital adoption of multiple health information exchange approaches and information accessibility.
J Am Med Inform Assoc 2020 Apr 1;27(4):577-83. doi: 10.1093/jamia/ocaa003..
Keywords: Health Information Technology (HIT), Health Information Exchange (HIE), Hospitals
Everson J, Adler-Milstein J
Sharing information electronically with other hospitals is associated with increased sharing of patients.
This study examined whether patient sharing between hospitals increased when they participated in a health information organization (HIO). The researchers used national data on hospital participation in HIOs from the American Hospital Association Information Technology Supplement and data on the volume of Medicare patients shared between pairs of hospitals from 2010 to 2016. They found that there an increase in patient sharing in competitive markets and with larger hospitals. Participation by only one hospital had no impact on patient sharing.
AHRQ-funded; HS026395.
Citation: Everson J, Adler-Milstein J .
Sharing information electronically with other hospitals is associated with increased sharing of patients.
Health Serv Res 2020 Feb;55(1):128-35. doi: 10.1111/1475-6773.13240..
Keywords: Health Information Technology (HIT), Health Information Exchange (HIE), Hospitals
Vest JR, Unruh MA, Casalino LP
The complementary nature of query-based and directed health information exchange in primary care practice.
Many policymakers and advocates assume that directed and query-based health information exchange (HIE) work together to meet organizations' interoperability needs, but this is not grounded in a substantial evidence base. This study sought to clarify the relationship between the usage of these 2 approaches to HIE. The investigators concluded that quantitative and qualitative findings suggested that directed and query-based HIE existed in a complementary manner in ambulatory care settings.
AHRQ-funded; HS024556.
Citation: Vest JR, Unruh MA, Casalino LP .
The complementary nature of query-based and directed health information exchange in primary care practice.
J Am Med Inform Assoc 2020 Jan;27(1):73-80. doi: 10.1093/jamia/ocz134..
Keywords: Health Information Exchange (HIE), Health Information Technology (HIT), Primary Care
Vest JR, Unruh MA, Freedman S
Health systems' use of enterprise health information exchange vs single electronic health record vendor environments and unplanned readmissions.
Enterprise health information exchange (HIE) and a single electronic health record (EHR) vendor solution are 2 information exchange approaches to improve performance and increase the quality of care. This study sought to determine the association between adoption of enterprise HIE vs a single vendor environment and changes in unplanned readmissions. The investigators concluded that reductions in the probability of an unplanned readmission after a hospital adopts a single vendor environment suggested that HIE technologies can better support the aim of higher quality care.
AHRQ-funded; HS024717.
Citation: Vest JR, Unruh MA, Freedman S .
Health systems' use of enterprise health information exchange vs single electronic health record vendor environments and unplanned readmissions.
J Am Med Inform Assoc 2019 Oct;26(10):989-98. doi: 10.1093/jamia/ocz116..
Keywords: Health Systems, Health Information Exchange (HIE), Electronic Health Records (EHRs), Health Information Technology (HIT), Hospital Readmissions, Hospitals
Vest JR, Unruh MA, Shapiro JS
The associations between query-based and directed health information exchange with potentially avoidable use of health care services.
This study quantified the impact of directed and query-based approaches to health information exchange (HIE) on potentially avoidable use of health care services. Data from Medicare fee-for-service claims was examined from 2008 to 2014 from providers in the Rochester Regional Health Organization (RHIO). There were very small reductions in the probability of ambulatory care sensitive hospitalization with either approach.
AHRQ-funded; HS024556.
Citation: Vest JR, Unruh MA, Shapiro JS .
The associations between query-based and directed health information exchange with potentially avoidable use of health care services.
Health Serv Res 2019 Oct;54(5):981-93. doi: 10.1111/1475-6773.13169..
Keywords: Health Information Exchange (HIE), Health Systems, Health Information Technology (HIT)
Lyles CR, Tieu L, Sarkar U
A randomized trial to train vulnerable primary care patients to use a patient portal.
This study examined the use of patient care portals in primary care practices with vulnerable patients such as those with lower socioeconomic status or limited health literacy (LHL). A randomized control trial was created with 93 English-speaking patients with 1+ chronic diseases. The patients were provided with either an 1) in-person tutorial with a research assistant, or 2) a link to view the videos on their own. A third arm of the trial were control patients with just normal access to get to the portal. There was a higher rate of access (21%) after the trial was over with the two intervention groups as compared with 9% for the usual care patients.
AHRQ-funded; HS022408; HS022561; HS023558.
Citation: Lyles CR, Tieu L, Sarkar U .
A randomized trial to train vulnerable primary care patients to use a patient portal.
J Am Board Fam Med 2019 Mar-Apr;32(2):248-58. doi: 10.3122/jabfm.2019.02.180263..
Keywords: Electronic Health Records (EHRs), Health Information Exchange (HIE), Health Literacy, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care, Vulnerable Populations
Ayer T, Ayvaci MUS, Karaca Z
Production and Operations Management 2019 Mar 2019;28(3):740–58.
Health information exchanges (HIEs) are expected to improve poor information coordination in emergency departments (EDs); however, whether and when HIEs are associated with better operational outcomes remains poorly understood. In this paper, the authors study HIE and length of stay (LOS) relationship using a large dataset from the Healthcare Cost and Utilization Project consisting of about 7.4 million treat‐and‐release visits made to 63 EDs in Massachusetts.
AHRQ-authored.
Citation: Ayer T, Ayvaci MUS, Karaca Z .
Production and Operations Management 2019 Mar 2019;28(3):740–58.
Production and Operations Management 2019 Mar;28(3):740–58..
Keywords: Emergency Department, Healthcare Cost and Utilization Project (HCUP), Health Information Exchange (HIE), Health Information Technology (HIT)
Lin SC, Hollingsworth JM, Adler-Milstein J
Alternative payment models and hospital engagement in health information exchange.
The purpose of this study was to assess whether hospital participation in alternative payment models (APMs) was associated with greater engagement in health information exchange (HIE) along 4 dimensions: volume of patients for whom information is exchanged, diversity of information types, breadth of partner types, and depth of technical approach. Findings suggest that APM participation was associated with greater HIE diversity, breadth, and depth that value-based payment may be spurring improvements in HIE infrastructure; however, the finding that APM participation is associated with lower HIE volume suggests that there may be incentive to focus HIE investments on a limited number of partners.
AHRQ-funded; HS024525; HS024728.
Citation: Lin SC, Hollingsworth JM, Adler-Milstein J .
Alternative payment models and hospital engagement in health information exchange.
Am J Manag Care 2019 Jan 1;25(1):e1-e6..
Keywords: Payment, Health Information Exchange (HIE), Hospitals
Vest JR, Simon K
Hospitals' adoption of intra-system information exchange is negatively associated with inter-system information exchange.
This study examined hospitals’ adoption of interoperability of health information technology (HIT). The relationship between hospitals’ intra- (within the same organization) and inter-system information exchange capabilities was explored using data from the 2010-2014 American Hospital Association’s Annual Health Information Technology Survey. As expected, there was more intra-system information exchange than inter-system but as time went on inter-system information exchange has increased. During the study period, hospitals were sharing 4.6 types of information by intra-system exchange, but only 2.7 types of information by inter-system exchange.
AHRQ-funded; HS024717.
Citation: Vest JR, Simon K .
Hospitals' adoption of intra-system information exchange is negatively associated with inter-system information exchange.
J Am Med Inform Assoc 2018 Sep;25(9):1189-96. doi: 10.1093/jamia/ocy058..
Keywords: Health Information Exchange (HIE), Health Systems, Health Information Technology (HIT), Hospitals
Walker DM
Does participation in health information exchange improve hospital efficiency?.
This study strives to answer the question: does health information exchange (HIE) network participation improve hospital efficiency? The results of the study suggest that hospital investment in HIE participation may be a useful strategy to improve hospital operational performance, and that policy should continue to support increased participation and use of HIE.
AHRQ-funded; HS023343.
Citation: Walker DM .
Does participation in health information exchange improve hospital efficiency?.
Health Care Manag Sci 2018 Sep;21(3):426-38. doi: 10.1007/s10729-017-9396-4..
Keywords: Care Coordination, Quality of Care, Health Information Technology (HIT), Hospitals, Health Information Exchange (HIE)
Cummins MR, Ranade-Kharkar P, Johansen C
Simple workflow changes enable effective patient identity matching in poison control.
In this study, to increase the documentation of patient identifiers by the Utah Poison Control Center (PCC), the authors (1) adapted documentation practices to enable more complete and consistent documentation, and (2) implemented staff training to improve collection of identifiers. The investigators found that compared with the same time period in 2016, the Utah PCC showed an increase of 27% (p < 0.001) in collection of birth date for cases referred to a health care facility, while improvements in the collection of other identifiers ranged from 0 to 8%.
AHRQ-funded; HS021472.
Citation: Cummins MR, Ranade-Kharkar P, Johansen C .
Simple workflow changes enable effective patient identity matching in poison control.
Appl Clin Inform 2018 Jul;9(3):553-57. doi: 10.1055/s-0038-1667000..
Keywords: Workflow, Health Information Exchange (HIE)
Shy BD, Loo GT, Lowry T
Bouncing back elsewhere: multilevel analysis of return visits to the same or a different hospital after initial emergency department presentation.
In this study, the investigators use a health information exchange network to describe differences between emergency department (ED) visits resulting in 72-hour revisits to the same hospital and those resulting in revisits to a different site. Their analysis describes how ED encounters with early revisits to the same hospital differ from those with revisits to a second hospital.
AHRQ-funded; HS021261.
Citation: Shy BD, Loo GT, Lowry T .
Bouncing back elsewhere: multilevel analysis of return visits to the same or a different hospital after initial emergency department presentation.
Ann Emerg Med 2018 May;71(5):555-63.e1. doi: 10.1016/j.annemergmed.2017.08.023..
Keywords: Emergency Department, Health Information Exchange (HIE), Hospital Readmissions, Quality Improvement
