The treatment of chronic diseases consumes 86% of U.S. healthcare costs. While healthcare organizations have traditionally focused on treating the complications of chronic diseases, advances in information technology (IT) and analytics can help clinicians and patients manage and slow the progression of chronic diseases to result in higher quality of life for patients and lower healthcare costs. We build on prior research to introduce the notion of temporal displacement of care (TDC), in which IT and analytics create healthcare value by displacing the time at which providers and patients make interventions to improve healthcare outcomes and reduce costs. We propose that healthcare value is created by strategic actions taken at specific points-in-time during the treatment process. Our theoretical development identifies TDC mechanisms through which IT and analytics displace later high cost interventions in favor of earlier preventative procedures. We test our hypotheses using four years of data on 45,000 cardio-metabolic patients from the U.S. state of Vermont, which implemented a Patient-Centered Medical Home (PCMH) program. Our study includes four cohorts with increasing levels of IT and analytics use: (i) non-PCMH practices, (ii) PCMH practices with basic IT systems installed, (iii) practices that completed data quality sprints (DQS) to increase use of IT systems, and (iv) practices that use analytics through the Vermont Healthcare Information Exchange (VHIE). Our results provide insights into how TDC effects develop over time. In Year 1 after implementation, the DQS cohort demonstrates a marked increase in the use of preventative procedures such as eye exams and neuropathy screenings, the increase becomes more pronounced in Years 2 and 3, and the increase is even greater for the VHIE cohort. As the use of preventative procedures increases, emergency department utilization decreases, with a more pronounced decrease for the VHIE cohort than the DQS cohort. By Year 2, the DQS and VHIE cohorts experience a decrease in total healthcare costs, with a greater decrease for the VHIE cohort than the DQS cohort. By Year 3, the healthcare outcomes indicator of Hemoglobin A1c (HbA1c) level is statistically significantly lower, with a greater decrease for the VHIE cohort than the DQS cohort. The increased use of low-intervention healthcare treatments earlier in the process leads to a decrease in overall healthcare costs, which then leads to an improvement in healthcare indicators.

中文翻译：

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慢性病管理：IT和分析如何通过护理的临时转移创造医疗保健价值

慢性疾病的治疗消耗了美国86％的医疗费用。尽管医疗保健组织传统上专注于治疗慢性疾病的并发症，但信息技术（IT）和分析技术的进步可以帮助临床医生和患者管理并减缓慢性疾病的进展，从而为患者带来更高的生活质量和更低的医疗保健成本。我们以先前的研究为基础，引入护理时移（TDC）的概念，其中IT和分析通过取代提供者和患者进行干预以改善医疗效果并降低成本的时间来创造医疗价值。我们建议通过在治疗过程中的特定时间点采取战略措施来创造医疗保健价值。我们的理论发展确定了TDC机制，IT和分析可通过该机制替代后期的高成本干预措施，而采用早期的预防措施。我们使用来自美国佛蒙特州的45,000名心脏代谢患者的四年数据验证了我们的假设，该患者实施了以患者为中心的医疗之家（PCMH）计划。我们的研究包括四个群组，这些群组的IT和分析使用水平不断提高：（i）非PCMH做法，（ii）安装了基本IT系统的PCMH做法，（iii）完成数据质量冲刺（DQS）以增加IT用途的做法系统，以及（iv）通过Vermont Healthcare Information Exchange（VHIE）使用分析的实践。我们的结果提供了有关TDC效果如何随着时间发展的真知灼见。实施后的第一年，DQS队列显示预防性程序（例如眼科检查和神经病变筛查）的使用显着增加，这种增加在2年级和3年级变得更加明显，而VHIE队列的增长甚至更大。随着预防程序的使用增加，急诊部门的利用率下降，VHIE队列比DQS队列明显减少。到第2年，DQS和VHIE队列的总医疗保健成本将下降，其中VHIE队列的下降幅度要大于DQS队列。到第3年，血红蛋白A1c（HbA1c）水平的医疗保健结果指标在统计​​学上显着降低，VHIE队列的下降幅度大于DQS队列的下降幅度。