Health Information Network Participation Profiles and Patient-Reported Discharge Information in U.S. Acute Care and Critical Access Hospitals

Background: U.S. hospitals participate in overlapping state or regional health information organizations (HIOs), national networks, electronic health record (EHR) vendor networks, and, increasingly, the Trusted Exchange Framework and Common Agreement (TEFCA).Earlier studies have linked health information exchange (HIE) to patient experience.However, we did not identify studies examining current combinations of HIO, national network, EHR vendor network, and TEFCA participation in relation to patient-reported discharge information, including whether these associations differ for critical access hospitals (CAHs).Objective: This study aims to examine whether hospital network participation profiles were associated with patient-reported discharge information and whether these associations differed between acute care hospitals and CAHs.Methods: We linked the 2022-2025 U.S. hospital participation in health information networks dataset from the Office of the National Coordinator for Health Information Technology (ONC) to Centers for Medicare & Medicaid Services (CMS) hospital and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data, the 2023 Agency for Healthcare Research and Quality (AHRQ) hospital linkage file, and 2023 Rural-Urban Continuum Codes (RUCC).The source cohort included 2,651 nonfederal acute care hospitals and CAHs whose latest ONC survey response was from 2024 or 2025.The exposure was a prespecified sixcategory profile combining HIO, national network, vendor network, and current TEFCA participation.The primary outcome was the adjusted HCAHPS percentage reporting receipt of recovery-at-home discharge information.We used multiple imputation to address missing hospital characteristics and inverse probability weighting to account for differences in public HCAHPS reporting.Regression models adjusted for hospital characteristics, state, and survey year.Results: The source cohort included 1,871 (70.6%) acute care hospitals and 780 (29.4%)CAHs.The primary outcome was publicly reported for 2,409 (90.9%) hospitals, including 1,852 (99.0%) of 1,871 acute care hospitals and 557 (71.4%) of 780 CAHs.Adjusted discharge-information scores differed across the six network profiles (Wald chi-square = 29.03,df = 5; P < 0.001), driven mainly by the single-conventionalnetwork category, whose difference from the three-network reference was -1.43 percentage points, with a 95% confidence interval (CI) of -2.09 to -0.76 (P < 0.001).Hospitals participating in all three conventional networks plus TEFCA scored 0.28 percentage points higher than hospitals using the same three networks without TEFCA (95% CI, -0.15 to 0.70; P = 0.206), a nonsignificant difference.The profile-by-hospital-type interaction was also not significant (Wald chi-square = 7.18, df = 5; P = 0.207).Findings were consistent across prespecified sensitivity analyses.Conclusions: Network participation patterns were related to patient-reported discharge information scores.Greater network participation did not consistently correspond to better performance, and TEFCA participation showed no clear additional association.We did not detect a significant difference in these relationships between acute care hospitals and CAHs.