INTRODUCTION: Use clinician perceptions to estimate the impact of a @entity283 ( @entity283 ) on emergency department (ED) care at four major @entity262 ( @entity262 ) within a region. Use survey data provided by ED clinicians to estimate reduction in Medicare-allowable reimbursements (MARs) resulting from use of an @entity283 . METHODS: We conducted the study during a one-year period beginning in February 2012. Study sites included eleven EDs operated by four major @entity262 in the region of a mid-sized Southeastern city, including one @entity341 , five community hospital EDs, four free-standing EDs and 1 ED/Chest Pain Center (CPC) all of which participated in an @entity283 . The study design was observational, prospective using a voluntary, anonymous, online survey. Eligible @entity1 included attending emergency physicians, residents, and mid-level providers (PA _ NP). Survey items asked clinicians whether information obtained from the @entity283 changed resource use while caring for @entity1 at the study sites and used branching logic to ascertain specific types of services avoided including laboratory/microbiology, radiology, consultations, and hospital admissions. Additional items asked how use of the @entity283 affected quality of care and length of stay. The survey was automated using a survey construction tool (REDCap Survey Software    2010 Vanderbilt University). We calculated avoided MARs by multiplying the numbers and types of services reported to have been avoided. Average cost of an admission from the ED was based on direct cost trends for ED admissions within the region. RESULTS: During the 12-month study period we had 325,740 @entity1 encounters and 7,525 logons to the @entity283 (utilization rate of 2.3%) by 231 ED clinicians practicing at the study sites. We collected 621 surveys representing 8.25% of logons of which 532 (85.7% of surveys) reported on @entity1 who had information available in the @entity283 . Within this group the following services and MARs were reported to have been avoided [type of service: number of services; MARs]: Laboratory/Microbiology:187;  2,073, Radiology: 298;  475,840, Consultations: 61;  6,461, Hospital Admissions: 56;  551,282. Grand total of MARs avoided:  1,035,654; average  1,947 per @entity1 who had information available in the @entity283 (Range:  1,491 -  2,395 between @entity262 ). Changes in management other than avoidance of a service were reported by 32.2% of @entity1 . @entity1 stated that quality of care was improved for 89% of @entity1 with information in the @entity283 . Eighty-two percent of @entity1 reported that valuable time was saved with a mean time saved of 105 minutes. CONCLUSION: Observational data provided by ED clinicians practicing at eleven EDs in a mid-sized Southeastern city showed an average reduction in MARs of  1,947 per @entity1 who had information available in an @entity283 . The majority of reduced MARs were due to avoided radiology studies and hospital admissions. Over 80% of @entity1 reported that quality of care was improved and valuable time was saved.

Impact of a XXXX on resource use and medicare-allowable reimbursements at 11 emergency departments in a midsized city.

@entity1 :: ('9606', 'Species') :: ['participants', 'patients', 'patient', 'Participants'] @entity341 :: ('MESH:D004630', 'Disease') :: ['academic ED'] @entity262 :: ('MESH:D034721', 'Disease') :: ['HS', 'hospital systems'] @entity283 :: ('OMIM:603663', 'Disease') :: ['health information exchange', 'HIE']
@entity283 :: (OMIM:603663,Disease) :: ['health information exchange']
