title: Meaningful Use and Hospital Performance on Post-Acute Utilization Indicators.
abstract: To examine trends in hospital post-acute utilization indicators and to determine whether improvement in these indicators is associated with attesting to meaningful use (MU).
  
  
  
  Medicare claims-based, repeated measures on 30-day hospital-wide all-cause readmission and emergency department (ED) utilization rates for 160 short-stay hospitals (2009-2012); Medicare EHR Incentive Program Payments files (2011-2012); and other hospital and market data.
  
  
  
  Interrupted time series with concurrent comparison group.
  
  
  
  Propensity score-weighted multilevel models for change demonstrate that 30-day readmission rates (unadjusted) fell from 13.4 percent in 2009 to 12.1 percent in 2012. Similarly, 30-day ED utilization declined from 18.9 percent to 17.3 percent during the same period. However, MU and non-MU hospitals were indistinguishable vis-à-vis performance. Controlling for hospital and market characteristics, MU was unrelated to 30-day readmission. In contrast, 30-day ED utilization deteriorated.
  
  
  
  Hospitals with MU Stage 1 designation did not show significantly higher improvement on post-acute utilization compared to their counterparts without. To achieve gains in quality and safety, potentially associated with EHRs, and to advance care coordination and patient engagement, the regulators should strengthen accountability by linking comprehensive, outcomes-based performance measures to specific MU objectives.
authors.affiliation: Department of Health Services, Policy, and Practice; CER/PCOR Scholar, Center for Evidence Synthesis in Health; Brown University School of Public Health, Providence, RI.
authors.forename: Yanick N
authors.initials: YN
authors.lastname: Brice
authors.affiliation: Harvard T. H. Chan School of Public Health, Harvard Medical School; Harvard University, Boston, MA.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Joynt
authors.affiliation: The Heller School for Social Policy and Management, Brandeis University, Waltham, MA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Tompkins
authors.affiliation: The Heller School for Social Policy and Management, Brandeis University, Waltham, MA.
authors.forename: Grant A
authors.initials: GA
authors.lastname: Ritter
mesh_terms: D057286:Electronic Health Records / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D065186:Interrupted Time Series Analysis; D062527:Meaningful Use / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012111:Residence Characteristics; D019467:Subacute Care / Q000706:statistics & numerical data*; D014481:United States
keywords: 30-day ED utilization; 30-day readmission; EHRs; Meaningful use