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A randomized trial of population-based clinical decision support to manage health and resource use for Medicaid beneficiaries.

Publication ,  Journal Article
Lobach, DF; Kawamoto, K; Anstrom, KJ; Silvey, GM; Willis, JM; Johnson, FS; Edwards, R; Simo, J; Phillips, P; Crosslin, DR; Eisenstein, EL
Published in: J Med Syst
February 2013

To determine whether a clinical decision support system can favorably impact the delivery of emergency department and hospital services. Randomized clinical trial of three clinical decision support delivery modalities: email messages to care managers (email), printed reports to clinic administrators (report) and letters to patients (letter) conducted among 20,180 Medicaid beneficiaries in Durham County, North Carolina with follow-up through 9 months. Patients in the email group had fewer low-severity emergency department encounters vs. controls (8.1 vs. 10.6/100 enrollees, p < 0.001) with no increase in outpatient encounters or medical costs. Patients in the letter group had more outpatient encounters and greater outpatient and total medical costs. There were no treatment-related differences for patients in the reports group. Among patients <18 years, those in the email group had fewer low severity (7.6 vs. 10.6/100 enrollees, p < 0.001) and total emergency department encounters (18.3 vs. 23.5/100 enrollees, p < 0.001), and lower emergency department ($63 vs. $89, p = 0.002) and total medical costs ($1,736 vs. $2,207, p = 0.009). Patients who were ≥18 years in the letter group had greater outpatient medical costs. There were no intervention-related differences in patient-reported assessments of quality of life and medical care received. The effectiveness of clinical decision support messaging depended upon the delivery modality and patient age. Health IT interventions must be carefully evaluated to ensure that the resultant outcomes are aligned with expectations as interventions can have differing effects on clinical and economic outcomes.

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Published In

J Med Syst

DOI

EISSN

1573-689X

Publication Date

February 2013

Volume

37

Issue

1

Start / End Page

9922

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Postal Service
  • Outcome and Process Assessment, Health Care
  • North Carolina
  • Medical Informatics
  • Medicaid
  • Male
  • Infant
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Lobach, D. F., Kawamoto, K., Anstrom, K. J., Silvey, G. M., Willis, J. M., Johnson, F. S., … Eisenstein, E. L. (2013). A randomized trial of population-based clinical decision support to manage health and resource use for Medicaid beneficiaries. J Med Syst, 37(1), 9922. https://doi.org/10.1007/s10916-012-9922-3
Lobach, David F., Kensaku Kawamoto, Kevin J. Anstrom, Garry M. Silvey, Janese M. Willis, Fred S. Johnson, Rex Edwards, et al. “A randomized trial of population-based clinical decision support to manage health and resource use for Medicaid beneficiaries.J Med Syst 37, no. 1 (February 2013): 9922. https://doi.org/10.1007/s10916-012-9922-3.
Lobach DF, Kawamoto K, Anstrom KJ, Silvey GM, Willis JM, Johnson FS, et al. A randomized trial of population-based clinical decision support to manage health and resource use for Medicaid beneficiaries. J Med Syst. 2013 Feb;37(1):9922.
Lobach, David F., et al. “A randomized trial of population-based clinical decision support to manage health and resource use for Medicaid beneficiaries.J Med Syst, vol. 37, no. 1, Feb. 2013, p. 9922. Pubmed, doi:10.1007/s10916-012-9922-3.
Lobach DF, Kawamoto K, Anstrom KJ, Silvey GM, Willis JM, Johnson FS, Edwards R, Simo J, Phillips P, Crosslin DR, Eisenstein EL. A randomized trial of population-based clinical decision support to manage health and resource use for Medicaid beneficiaries. J Med Syst. 2013 Feb;37(1):9922.
Journal cover image

Published In

J Med Syst

DOI

EISSN

1573-689X

Publication Date

February 2013

Volume

37

Issue

1

Start / End Page

9922

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Postal Service
  • Outcome and Process Assessment, Health Care
  • North Carolina
  • Medical Informatics
  • Medicaid
  • Male
  • Infant
  • Humans