To test for correlation between the growth in adoption of ambulatory electronic health records (s) in the United States during 2010–2013 and hospital admissions and readmissions for elderly Medicare beneficiaries with at least one of four common ambulatory care–sensitive conditions (s).
&A Information Services Survey of Physicians, American Hospital Association General Survey and Information Technology Supplement; and the Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse Geographic Variation Database for 2010 through 2013.
Fixed effects model estimated the relationship between hospital referral region () level measures of physician adoption and admissions and readmissions. Analyzed rates of admissions and 30‐day readmissions per beneficiary at the level (restricting the denominator to beneficiaries in our sample), adjusted for differences across s in Medicare beneficiary age, gender, and race. Calculated physician adoption rates as the percentage of physicians in each who report using in ambulatory care settings.
Each percentage point increase in market‐level adoption by physicians is correlated with a statistically significant decline of 1.06 admissions per 10,000 beneficiaries over the study period, controlling for the overall time trend as well as market fixed effects and characteristics that changed over time. This finding implies 26,689 fewer admissions in our study population during 2010 to 2013 that were related to physician ambulatory adoption. This represents 3.2 percent fewer admissions relative to the total number of such admissions in our study population in 2010. We found no evidence of a correlation between use, by either physicians or hospitals, and hospital readmissions at either the market level or hospital level.
This study extends knowledge about s' relationship with quality of care and utilization. The results suggest a significant association between use in ambulatory care settings and admissions that is consistent with policy goals to improve the quality of ambulatory care for patients with chronic conditions. The null findings for readmissions support the need for improved interoperability between ambulatory care s and hospital s to realize improvements in readmissions.
