What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: High-need patients (recurrent healthcare utilization) (n=2549). Intervention: Single-institution (VUMC) EHR screening criteria vs. Statewide Admission, Discharge, and Transfer (ADT) feed reference standard. Primary outcome: Sensitivity of VUMC-only criteria for identifying high-need patients (95% CI 98.7-99.5).

What does this research mean for the field?

Relying on single-institution electronic health record data to identify high-need patients yields high sensitivity (99.1%) and minimal selection bias across race and insurance compared to using statewide admission, discharge, and transfer feeds. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 17, 2023BMC Health Services Research4 citationsOpen Access

Screening for the high-need population using single institution versus state-wide admissions discharge transfer feed

FBFrancis Salvador BalucanVanderbilt University Medical Center BFBenjamin FrenchCardiac Imaging YSYaping ShiHenan University Huaihe Hospital and Huaihe Clinical Institute

Key Result

Single-institution electronic health record screening criteria demonstrated 99.1% sensitivity in identifying high-need patients compared to a statewide admission, discharge, and transfer feed.

Study Design

Type

Cross-Sectional (n=2,549)

Multicenter

Structured PICO

Does single-institution EHR screening accurately identify high-need patients compared to a statewide ADT feed?

Population

2,549 patients 18 years or older with at least one ED visit or hospitalization at Vanderbilt University Medical Center (VUMC) and assessed as high-need (≥3 ED visits or hospitalizations in Tennessee) based on the statewide ADT from January 1 to June 30, 2021.

Intervention

Screening for high-need patients using single-institution (VUMC) Epic EHR database

Comparator

Screening using statewide Admission, Discharge, and Transfer (ADT) feed (reference standard)

Outcome

Sensitivity of VUMC-only criteria for identifying high-need patients compared to the statewide ADT reference standard

Single-institution EHR data showed high sensitivity (99.1%) in identifying high-need patients compared to a statewide ADT feed, suggesting minimal selection bias at this specific center.

Limitations

Could only identify high-need patients who had a relationship with VUMC through a hospital or ED visit during the study period
Cannot quantify the total high-need population within the middle Tennessee catchment area
Cannot calculate the specificity and negative predictive value of the current screening criteria
The institutional criteria for high-need do not match Medicare's definition, which combines admissions and HCC score data

Abstract

BACKGROUND: Access to programs for high-needs patients depending on single-institution electronic health record data (EHR) carries risks of biased sampling. We investigate a statewide admission, discharge, and transfer feed (ADT) in assessing equity in access to these programs. METHODS: This is a retrospective cross-sectional study. We included high-need patients at Vanderbilt University Medical Center (VUMC) 18 years or older, with at least three emergency visits (ED) or hospitalizations in Tennessee from January 1 to June 30, 2021, including at least one at VUMC. We used the Tennessee ADT database to identify high-need patients with at least one VUMC ED/hospitalization. Then, we compared this population with high-need patients identified using VUMC's Epic® EHR database. The primary outcome was the sensitivity of VUMC-only criteria for identifying high-need patients compared to the statewide ADT reference standard. RESULTS: We identified 2549 patients with at least one ED/hospitalization and assessed them as high-need based on the statewide ADT. Of those, 2100 had VUMC-only visits, and 449 had VUMC and non-VUMC visits. VUMC-only visit screening criteria showed high sensitivity (99.1%, 95% CI: 98.7 - 99.5%), showing that the high-needs patients admitted to VUMC infrequently access alternative systems. Results showed no meaningful difference in sensitivity when stratified by patient's race or insurance. CONCLUSIONS: ADT allows examination for potential selection bias when relying upon single-institution utilization. In VUMC's high-need patients, there's minimal selection bias when depending on same-site utilization. Further research must understand how biases vary by site and durability over time.

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