Background: Patients with co-occurring behavioral health and chronic medical conditions frequently overuse inpatient hospital services. This pattern of overuse contributes to inefficient health care spending. These patients require coordinated care to achieve optimal health outcomes. However, the poor exchange of health-related information between various clinicians renders the delivery of coordinated care challenging. Health information exchanges (HIEs) facilitate health-related information sharing and have been shown to be effective in chronic disease management; however, their effectiveness in the delivery of integrated care is less clear. It is prudent to consider new approaches to sharing both general medical and behavioral health information. Objective: This study aims to identify and describe factors influencing the intention to use behavioral health information that is shared through HIEs. Methods: We used a mixed methods design consisting of two sequential phases. A validated survey instrument was emailed to clinical and nonclinical staff in Alabama and Oklahoma. The survey captured information about the impact of predictors on the intention to use behavioral health data in clinical decision making. Follow-up interviews were conducted with a subsample of participants to elaborate on the survey results. Partial least squares structural equation modeling was used to analyze survey data. Thematic analysis was used to identify themes from the interviews. Results: A total of 62 participants completed the survey. In total, 63% (n=39) of the participants were clinicians. Performance expectancy (β=.382; P=.01) and trust (β=.539; P<.001) predicted intention to use behavioral health information shared via HIEs. The interviewees (n=5) expressed that behavioral health information could be useful in clinical decision making. However, privacy and confidentiality concerns discourage sharing this information, which is generally missing from patient records altogether. The interviewees also stated that training for HIE use was not mandatory; the training that was provided did not focus specifically on the exchange of behavioral health information. Conclusions: Despite barriers, individuals are willing to use behavioral health information from HIEs if they believe that it will enhance job performance and if the information being transmitted is trustworthy. The findings contribute to our understanding of the role HIEs can play in delivering integrated care, particularly to vulnerable patients.

中文翻译：

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使用来自健康信息交换的行为健康数据的意图：混合方法研究

背景：行为健康和慢性病并发的患者经常过度使用住院医院服务。这种过度使用的模式导致医疗保健支出效率低下。这些患者需要协调护理，以达到最佳的健康效果。然而，各临床医生之间健康信息交流不畅，使得协调医疗的提供面临挑战。健康信息交流（HIE）促进了与健康相关的信息共享，并已被证明在慢性疾病管理中是有效的；但是，它们在提供综合护理方面的有效性尚不清楚。谨慎考虑共享通用医疗和行为健康信息的新方法。客观的：这项研究旨在确定和描述影响通过HIE共享行为健康信息的意图的因素。方法：我们使用了由两个连续阶段组成的混合方法设计。经过验证的调查工具已通过电子邮件发送给阿拉巴马州和俄克拉荷马州的临床和非临床人员。该调查收集了有关预测因素对在临床决策中使用行为健康数据的意图的影响的信息。对参与者的子样本进行了后续访谈，以详细说明调查结果。使用偏最小二乘结构方程建模来分析调查数据。主题分析用于从访谈中识别主题。结果：共有62位参与者完成了调查。总计63％（n = 39）的参与者是临床医生。绩效预期（β = .382；P = .01）和信任度（β = .539；P <.001）预测了使用通过HIE共享的行为健康信息的意图。被访者（n = 5）表示，行为健康信息可能对临床决策有用。但是，隐私和机密性使我们不愿共享此信息，而患者信息通常通常会完全丢失这些信息。受访者还说，使用HIE的培训不是强制性的。提供的培训并不专门针对行为健康信息的交换。结论：尽管存在障碍，但个人愿意使用HIE的行为健康信息，前提是他们认为这将提高工作绩效，并且所传输的信息是可信赖的。这些发现有助于我们了解HIE在提供综合医疗服务（尤其是向弱势患者提供医疗服务）中可以发挥的作用。