Does health information exchange reduce unnecessary neuroimaging and improve quality of headache care in the emergency department?

BACKGROUND: Health information exchange (HIE) is advocated as an approach to reduce unnecessary testing and improve quality of emergency department (ED) care, but little evidence supports its use. Headache is a specific condition for which HIE has theoretical benefits. OBJECTIVE: To determine whether health information exchange (HIE) reduces potentially unnecessary neuroimaging, increases adherence with evidence-based guidelines, and decreases costs in the emergency department (ED) evaluation of headache. DESIGN: Longitudinal data analysis SUBJECTS: All repeat patient-visits (N = 2,102) by all 1,252 adults presenting with headache to a Memphis metropolitan area ED two or more times between August 1, 2007 and July 31, 2009. INTERVENTION: Use of a regional HIE connecting the 15 major adult hospitals and two regional clinic systems by authorized ED personnel to access the patient's record during the time period in which the patient was being seen in the ED. MAIN MEASURES: Diagnostic neuroimaging (CT, CT angiography, MRI or MRI angiography), evidence-based guideline adherence, and total patient-visit estimated cost. KEY RESULTS: HIE data were accessed for 21.8 % of ED patient-visits for headache. 69.8 % received neuroimaging. HIE was associated with decreased odds of diagnostic neuroimaging (odds ratio [OR] 0.38, confidence interval [CI] 0.29-0.50) and increased adherence with evidence-based guidelines (OR 1.33, CI 1.02-1.73). Administrative/nursing staff HIE use (OR 0.24, CI 0.17-0.34) was also associated with decreased neuroimaging after adjustment for confounding factors. Overall HIE use was not associated with significant changes in costs. CONCLUSIONS: HIE is associated with decreased diagnostic imaging and increased evidence-based guideline adherence in the emergency evaluation of headache, but was not associated with improvements in overall costs. Controlled trials are needed to test whether specific HIE enhancements to increase HIE use can further reduce potentially unnecessary diagnostic imaging and improve adherence with guidelines while decreasing costs of care.

The three Tennessees: child and infant health in the three Grand Divisions of Tennessee.

Tennessee consistently ranks low among all states in measures of health. This study was undertaken to examine the differences in child and infant health conditions in the state's three Grand Divisions and the impact of these differences on Tennessee's overall rankings. An analysis of county-level data selected from the Area Resources File demonstrated that, for most measures of infant health and child health, the three divisions ranked very differently and that the overall state ranking did not accurately reflect the conditions in the divisions. Some regions, most often Middle Tennessee, ranked much higher than did the state as a whole; other regions, most often West Tennessee, ranked lower. The single overall state ranking masked these regional differences while suggesting that the entire state had equally low health outcomes. The striking health variations among the divisions that were demonstrated highlight the need to examine health conditions and implement health improvement efforts on a regional rather than a statewide basis.