title: Randomized Trial of Population-Based Clinical Decision Support to Facilitate Care Transitions.
abstract: Medicaid beneficiaries in 6 North Carolina counties were randomly assigned to 1 of 3 clinical decision support (CDS) care transition strategies: (1) usual care (Control), (2) CDS messaging to patients and their medical homes (Reports), or (3) CDS messaging to patients, their medical homes, and their care managers (Reports+). We included 7146 Medicaid patients and evaluated transitions from specialist visit, ER and hospital encounters back to the patient's medical home. Patients enrolled in Medicare and Medicaid were not eligible. The number of care manager contacts was greater for patients in the Reports+ Group than in the Control Group. However, there were no treatment-related differences in emergency department (ED) encounter rates, or in the secondary outcomes of outpatient and hospital encounter rates and medical costs. Study monitors found study intervention documentation in approximately 60% of patient charts. These results highlight the importance of effectively integrating information interventions into healthcare delivery workflow systems.
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Eisenstein
authors.affiliation: Department of Community and Family Medicine, Duke University, Durham, NC.
authors.forename: Janese M
authors.initials: JM
authors.lastname: Willis
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Rex
authors.initials: R
authors.lastname: Edwards
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.affiliation: Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Kensaku
authors.initials: K
authors.lastname: Kawamoto
authors.affiliation: Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Guilherme Del
authors.initials: GD
authors.lastname: Fiol
authors.affiliation: Department of Community and Family Medicine, Duke University, Durham, NC.
authors.forename: Fred S
authors.initials: FS
authors.lastname: Johnson
authors.affiliation: Department of Community and Family Medicine, Duke University, Durham, NC.
authors.forename: David F
authors.initials: DF
authors.lastname: Lobach
mesh_terms: D003365:Costs and Cost Analysis; D020000:Decision Support Systems, Clinical; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D017721:Hospital Costs; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D009657:North Carolina; D010360:Patient Transfer; D018802:Patient-Centered Care / Q000706:statistics & numerical data; D013038:Specialization / Q000191:economics / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States
keywords: care transitions; clinical decision support; complex patients