Interspecialty Communication Supported by Health Information Technology Associated with Lower Hospitalization Rates for Ambulatory Care-Sensitive Conditions

Journal of the American Board of Family Medicine

Background: Practice tools, such as health information technology (HIT), can potentially support care processes, such as communication between health care providers, and influence care for so-called ambulatory care-sensitive conditions (ACSCs). Good outpatient care can potentially prevent the need for hospitalization of patients with ACSCs. To date, associations between primary care practice capabilities and hospitalizations for ambulatory care-sensitive conditions primarily have been limited to smaller, local studies or unique delivery systems rather than nationally representative studies of U.S. primary care physicians.

Methods: Researchers analyzed a nationally representative sample of 1,819 primary care physicians who responded to the Center for Studying Health System Change’s Physician Survey. We linked three years of Medicare claims (2007 to 2009) with these primary care physician survey respondents. This linkage resulted in the identification of 123,760 beneficiaries with one or more of four ACSCs—diabetes, chronic obstructive pulmonary disease, asthma and congestive heart failure—and physicians who served as their usual provider. Key independent variables of interest were physicians’ practice capabilities, including communication with specialists, use of care managers, participation in quality and performance measurement, use of patient registries, and HIT use. The dependent variable was a summary measure of ambulatory care-sensitive hospitalizations for one or more of the four identified conditions.

Results: Higher provider-reported levels of communication between primary care and specialist physicians were associated with lower rates of potentially avoidable hospitalizations. While there was no significant main effect between HIT use and ACSC hospitalizations, the associations between interspecialty communication and ACSC hospitalizations were magnified in the presence of higher HIT use. For example, patients in practices with both the highest level of interspecialty communication and the highest level of HIT use had lower odds of ambulatory care-sensitive hospitalizations than did those in practices with lower interspecialty communication and high HIT use (adjusted odds ratio, 0.70; 95% confidence limits, 0.59, 0.82).

Conclusions: Greater primary care and specialist communication is associated with reduced hospitalizations for ambulatory care-sensitive conditions. This effect was magnified in the presence of higher provider-reported HIT use, suggesting that coordination of care with support from HIT is important in the treatment of ambulatory care-sensitive conditions.

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