Leveraging a health information exchange to examine the accuracy of self-report emergency department utilization data among hospitalized injury survivors
Open Access
- 28 January 2021
- journal article
- research article
- Published by BMJ in Trauma Surgery & Acute Care Open
- Vol. 6 (1), e000550
- https://doi.org/10.1136/tsaco-2020-000550
Abstract
Background Accurate acute care medical utilization history is an important outcome for clinicians and investigators concerned with improving trauma center care. The objective of this study was to examine the accuracy of self-report emergency department (ED) utilization compared with utilization obtained from the Emergency Department Information Exchange (EDIE) in admitted trauma surgery patients with comorbid mental health and substance use problems. Methods This is a retrospective cohort study of 169 injured patients admitted to the University of Washington’s Harborview Level I Trauma Center. Patients had high levels of post-traumatic stress disorder and depressive symptoms, suicidal ideation and alcohol comorbidity. The investigation used EDIE, a novel health technology tool that collects information at the time a patient checks into any ED in Washington and other US states. Patterns of EDIE-documented visits were described, and the accuracy of injured patients’ self-report visits was compared with EDIE-recorded visits during the course of the 12 months prior to the index trauma center admission. Results Overall, 45% of the sample (n=76) inaccurately recalled their ED visits during the past year, with 36 participants (21%) reporting less ED visits than EDIE indicated and 40 (24%) reporting more ED visits than EDIE indicated. Patients with histories of alcohol use problems and major psychiatric illness were more likely to either under-report or over-report ED health service use. Discussion Nearly half of all patients were unable to accurately recall ED visits in the previous 12 months compared with EDIE, with almost one-quarter of patients demonstrating high levels of disagreement. The improved accuracy and ease of use when compared with self-report make EDIE an important tool for both clinical and pragmatic trial longitudinal outcome assessments. Orchestrated investigative and policy efforts could further examine the benefits of introducing EDIE and other information exchanges into routine acute care clinical workflows. Level of evidence II/III. Trial registration number ClinicalTrials.gov NCT02274688.Keywords
Funding Information
- National Institutes of Health (K23DA039974, R25MH08091607)
- Patient-Centered Outcomes Research Institute (IH-1304-6319)
This publication has 43 references indexed in Scilit:
- A Randomized Stepped Care Intervention Trial Targeting Posttraumatic Stress Disorder for Surgically Hospitalized Injury SurvivorsAnnals of Surgery, 2013
- Concordance between self-reports and archival records of physician visits: A case–control study comparing individuals with and without alcohol use disorders in the communityDrug and Alcohol Dependence, 2011
- AUDIT‐C as a Brief Screen for Alcohol Misuse in Primary CareAlcohol: Clinical and Experimental Research, 2007
- Self-Reported Utilization of Health Care Services: Improving Measurement and AccuracyMedical Care Research and Review, 2006
- A National Evaluation of the Effect of Trauma-Center Care on MortalityThe New England Journal of Medicine, 2006
- Unmet substance abuse treatment need, health services utilization, and cost: A population-based emergency department studyAnnals of Emergency Medicine, 2005
- The PHQ-9Journal of General Internal Medicine, 2001
- Psychometric properties of the PTSD checklist (PCL)Behaviour Research and Therapy, 1996
- Urban TraumaThe Journal of Trauma and Acute Care Surgery, 1989
- The Validity of Self-reported Physician Utilization MeasuresMedical Care, 1984