Hospital health information exchange participation and heart failure discharges to skilled nursing facilities: a cohort study

Health information technologies, such as telehealth and remote monitoring, show promise in preventing admission to skilled nursing facilities (SNF) following hospital discharges among older adults with heart failure (HF). Other health information technologies such as health information exchange (HIE), have not been examined as a potential means to reduce the use of SNF following HF hospitalization in older adults. Using the 2018 Medicare Provider Analysis and Review (MedPar) file, we identified Medicare beneficiaries admitted for HF in 2018 and used unadjusted and adjusted logistic regression to examine associations between hospital HIE participation and the odds of being discharged to SNF; models were stratified by whether the beneficiary was admitted from a SNF or not. Among 385,895 HF admissions, 21.9% were discharged to SNF. Hospital HIE participation was not significantly associated with the odds of being discharged to SNF in beneficiaries not admitted from a SNF (AOR 0.97, 95% CI 0.95, 1.00); participating in HIE was associated with a 17% decrease in the odds of being discharged to SNF (AOR 0.83, 95% CI 0.73, 0.95), among beneficiaries admitted from a SNF, compared to hospitals where no HIE was available. Hospital HIE participation may be insufficient to impact the discharge destination for most older adults. Expanding information exchange beyond a narrow definition of “healthcare” to SNFs, other long-term care facilities and community health services may have an outsize impact on patient outcomes.