PMID- 37848976
OWN - NLM
STAT- MEDLINE
DCOM- 20231023
LR  - 20240210
IS  - 1472-6963 (Electronic)
IS  - 1472-6963 (Linking)
VI  - 23
IP  - 1
DP  - 2023 Oct 17
TI  - Screening for the high-need population using single institution versus state-wide 
      admissions discharge transfer feed.
PG  - 1111
LID - 10.1186/s12913-023-10017-5 [doi]
LID - 1111
AB  - BACKGROUND: Access to programs for high-needs patients depending on 
      single-institution electronic health record data (EHR) carries risks of biased 
      sampling. We investigate a statewide admission, discharge, and transfer feed 
      (ADT) in assessing equity in access to these programs. METHODS: This is a 
      retrospective cross-sectional study. We included high-need patients at Vanderbilt 
      University Medical Center (VUMC) 18 years or older, with at least three emergency 
      visits (ED) or hospitalizations in Tennessee from January 1 to June 30, 2021, 
      including at least one at VUMC. We used the Tennessee ADT database to identify 
      high-need patients with at least one VUMC ED/hospitalization. Then, we compared 
      this population with high-need patients identified using VUMC's Epic(R) EHR 
      database. The primary outcome was the sensitivity of VUMC-only criteria for 
      identifying high-need patients compared to the statewide ADT reference standard. 
      RESULTS: We identified 2549 patients with at least one ED/hospitalization and 
      assessed them as high-need based on the statewide ADT. Of those, 2100 had 
      VUMC-only visits, and 449 had VUMC and non-VUMC visits. VUMC-only visit screening 
      criteria showed high sensitivity (99.1%, 95% CI: 98.7 - 99.5%), showing that the 
      high-needs patients admitted to VUMC infrequently access alternative systems. 
      Results showed no meaningful difference in sensitivity when stratified by 
      patient's race or insurance. CONCLUSIONS: ADT allows examination for potential 
      selection bias when relying upon single-institution utilization. In VUMC's 
      high-need patients, there's minimal selection bias when depending on same-site 
      utilization. Further research must understand how biases vary by site and 
      durability over time.
CI  - (c) 2023. BioMed Central Ltd., part of Springer Nature.
FAU - Balucan, Francis Salvador
AU  - Balucan FS
AD  - Section of Hospital Medicine, Division of General Internal Medicine and Public 
      Health, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN, 
      37212, USA. francis.g.balucan@vumc.org.
FAU - French, Benjamin
AU  - French B
AD  - Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, 
      USA.
FAU - Shi, Yaping
AU  - Shi Y
AD  - Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, 
      USA.
FAU - Kripalani, Sunil
AU  - Kripalani S
AD  - Section of Hospital Medicine, Division of General Internal Medicine and Public 
      Health, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN, 
      37212, USA.
AD  - Vanderbilt Center for Health Services Research, Nashville, TN, USA.
AD  - Vanderbilt Center for Clinical Quality and Implementation Research, Nashville, 
      TN, USA.
FAU - Vasilevskis, Eduard E
AU  - Vasilevskis EE
AD  - Section of Hospital Medicine, Division of General Internal Medicine and Public 
      Health, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN, 
      37212, USA.
AD  - Vanderbilt Center for Health Services Research, Nashville, TN, USA.
AD  - Vanderbilt Center for Clinical Quality and Implementation Research, Nashville, 
      TN, USA.
AD  - Geriatric Research Education and Clinical Center, VA Tennessee Valley, Nashville, 
      TN, USA.
LA  - eng
GR  - UL1 TR002243/TR/NCATS NIH HHS/United States
PT  - Journal Article
DEP - 20231017
PL  - England
TA  - BMC Health Serv Res
JT  - BMC health services research
JID - 101088677
SB  - IM
UOF - Res Sq. 2023 Mar 16;:. PMID: 36993433
MH  - Humans
MH  - *Patient Discharge
MH  - Retrospective Studies
MH  - Cross-Sectional Studies
MH  - *Hospitalization
MH  - Tennessee
MH  - Emergency Service, Hospital
PMC - PMC10583334
OTO - NOTNLM
OT  - Admission discharge transfer feed
OT  - Digital redlining
OT  - Health equity
OT  - High need high cost population
COIS- The authors declare no competing interests.
EDAT- 2023/10/18 06:43
MHDA- 2023/10/23 01:18
PMCR- 2023/10/17
CRDT- 2023/10/18 00:02
PHST- 2023/02/08 00:00 [received]
PHST- 2023/09/11 00:00 [accepted]
PHST- 2023/10/23 01:18 [medline]
PHST- 2023/10/18 06:43 [pubmed]
PHST- 2023/10/18 00:02 [entrez]
PHST- 2023/10/17 00:00 [pmc-release]
AID - 10.1186/s12913-023-10017-5 [pii]
AID - 10017 [pii]
AID - 10.1186/s12913-023-10017-5 [doi]
PST - epublish
SO  - BMC Health Serv Res. 2023 Oct 17;23(1):1111. doi: 10.1186/s12913-023-10017-5.