Introduction
The Veterans Health Information Exchange (VHIE)¹ enables the exchange of data between the Veterans Administration (VA) and outside healthcare organizations. Within the VA, admission, discharge, transfer (ADT) alerts can be important notifications to support quality improvement as well as care coordination. Using VHIE, non-VA community health partners can notify VA clinicians and staff when Veterans seek care outside the VA.² This can lead to timely and appropriate follow-up after patient discharge.
Methods
In this study, we sought to describe early patterns of non-VA alerts from community partners using data extracted from ADT messages sent via VHIE. A notification protocol within the electronic medical record was configured to notify VA providers of a patient’s non-VA event. Sent within 24-72 hours of a patient’s non-VA event, these alerts include information such patient demographics, visit type (e.g., emergency, inpatient, outpatient), and changes in status (e.g., discharge from or transfer to a facility).³ We examined ADT notifications sent to two VA medical centers located in Salt Lake City, UT and San Diego, CA during the 2017 calendar year. Descriptive analyses were used to examine patterns in the data received from non-VA facilities as well as the incidence of non-VA care.
Results
A majority of Veterans seeking care in non-VA facilities were male (86.8%) and non-Hispanic white (78.6) followed by black (2.0%). Outpatient visits constituted 64.4% of total non-VA encounters while emergency room and inpatient admissions constituted 22.2% and 13.4%, respectively, in Salt Lake City. Similarly, the San Diego site observed 53.6% of total outpatient visits while emergency room and inpatient admissions constituted 29.3% and 17.1%, respectively. In the outpatient setting, an average of 24 patients in Salt Lake City (60.6%) and 141 patients in San Diego (54.2%) were identified as repeat visitors (2 or more visits) within the same month representing the largest proportion of repeat visits.
Discussion
ADT notifications provide an important opportunity for population health management and improving the health outcomes of Veterans at high risk for hospital readmission. ADT alerts potentially offer several benefits which include identifying patients that are hospitalized or seeking care in other medical facilities, improving health care quality by increasing provider awareness of their patients’ health history, allowing hospitals to track patients and prompt intervention when needed, and supporting care coordination and transition. Lessons learned may provide solutions to challenges faced in population health management such as tracking patients between discrete points of care using HIE.

Learning Objective: Understand how to leverage ADT alerts to support quality improvement for health care teams

Authors:

Willi Tarver (Presenter)
Roudebush VA Medical Center

Omar Bouhaddou, US Department of Veterans Affairs
nitin jain, US Department of Veterans Affairs
Brian Dixon, Roudebush VA Medical Center

Presentation Materials:

• Abstract/Manuscript - 1