title: Interspecialty communication supported by health information technology associated with lower hospitalization rates for ambulatory care-sensitive conditions.
abstract: BACKGROUND
  Practice tools such as health information technology (HIT) have the potential to support care processes, such as communication between health care providers, and influence care for "ambulatory care-sensitive conditions" (ACSCs). ACSCs are conditions for which good outpatient care can potentially prevent the need for hospitalization. To date, associations between such primary care practice capabilities and hospitalizations for ambulatory care-sensitive conditions have been primarily limited to smaller, local studies or unique delivery systems rather than nationally representative studies of primary care physicians in the United States.
  
  
  METHODS
  We 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 3 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 4 ambulatory care-sensitive chronic conditions (diabetes, chronic obstructive pulmonary disease, asthma, and congestive heart failure) for whom these physicians served as the 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 these 4 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.
authors.affiliation: From the Center for Studying Health System Change, Washington, DC (ASO, JDR); and Social and Scientific Systems, Silver Spring, MD (CS-M). aomalley@mathematica-mpr.com.
authors.forename: Ann S
authors.initials: AS
authors.lastname: O'Malley
authors.affiliation: From the Center for Studying Health System Change, Washington, DC (ASO, JDR); and Social and Scientific Systems, Silver Spring, MD (CS-M).
authors.forename: James D
authors.initials: JD
authors.lastname: Reschovsky
authors.affiliation: From the Center for Studying Health System Change, Washington, DC (ASO, JDR); and Social and Scientific Systems, Silver Spring, MD (CS-M).
authors.forename: Cynthia
authors.initials: C
authors.lastname: Saiontz-Martinez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D002908:Chronic Disease / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008490:Medical Informatics / Q000458:organization & administration*; D006278:Medicare; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care / Q000458:organization & administration*; D014481:United States
keywords: Health Care Systems; Information Systems; Prevention & Control; Primary Health Care; Quality of Health Care