Given the goals of the IMPACT project to improve speed and quality of care during the transitions process, several areas require evaluation for this project.
The first crucial aspect of the project is to evaluate which of the Universal Transfer Form data elements are necessary for which transfer type for each provider type. If the evaluation team is able to determine which elements are necessary for each transfer type, the CCD+ (the electronic version of the UTF) will be able to be parsed to present only those elements each type of provider and transfer type requires. Members of the IMPACT Galaxy will receive a template and be asked to evaluate the 300 data elements on the UTF as receivers of data to help determine which groups need which types of data.
The Evaluation Team has determined that there are two primary groups within the participating groups where focus must be placed: the senders of information and the receivers of information. At any given point in time, a provider in a given facility can be either a sender or receiver. The figure above describes the type of institutions and the possibilities of transition type that can happen between these organizations. The needs of the receiving facility for certain information will be weighed against the difficulty for the sending institution to gather that information. We also expect that over time, the data needs for the receiving institution may change and those changing needs must be captured in some way – we do not expect that the data elements of the UTF should remain static over time. To that end, the CCD+ will include a short survey with several questions to be administered, on a random basis, to both senders and receivers. The survey will differ depending on if the user is identified as the sender or receiver. By building ongoing evaluation into the workflow of senders and receivers, our goal is to facilitate evolution of the required data elements to reflect changes in clinical practice.
The scope of Evaluation extends to all of the Highest and Second Priority transitions which are indicated on the following Sender/Receiver Grid. The focus of IMPACT is on transitions to and from PAC sites broadly defined to include the Ambulatory Care Office and the Patient and family at home in addition to the sites traditionally included in post acute care. Many other important transitions are not included in this initial set but will need to be addressed in subsequent efforts to expand information exchange via HIE.
Another part of Evaluation focuses on the process of implementation and adoption of the UTF across the sender and receiver sites. Following the balloting for elements to be included in the UTF, the next phase is to assess the processes needed to identify and extract the data elements. Initially these elements will be compiled using paper forms and transmitted via fax or on paper to the next site. Over time, more and more of the transmission will occur electronically as LAND and SEE are deployed.
An important component of Evaluation will be measures of “efficiency” and non-value added re-work that result from incomplete data exchange at transfer. Our hypothesis is that improved information exchange will significantly reduce the “cost” of transfers.
As the progression from current state to UTF via paper to UTF via HIE occurs, we will be monitoring the impact of improved clinical transitions on health care resource utilization. Because we have access to health insurance claims data covering a large percentage of Worcester County residents, we will be able to correlate any changes in utilization with the mechanism of health information exchange. We will also track unplanned emergency department visits, readmissions and total admissions.
We will use the Coleman CTM3 measure set to assess the impact of improved information sharing with patients and families at discharge on preparedness to assume self care. All receivers, including patients and family, will be part of an ongoing satisfaction survey as well.
We will be able to analyze our data at multiple levels of aggregation. At the highest level we can compare the cost of “episodes of care” that include all health care utilization at all sites of care by similar patients correlated to the completeness of information exchange and the process used to achieve it. At intermediate levels we can track the impact of moving from paper to HIE within particular sites of care. At more granular levels we will be able to aggregate patient and site specific experience with high risk/high utilizing patient groups such as those with CHF, COPD, ESRD and other complex chronic conditions.