Volume 54 | Number 5 | October 2019

Abstract List

Joshua R. Vest, Mark Aaron Unruh Ph.D., Jason S. Shapiro MD, Lawrence P. Casalino M.D., Ph.D.


To quantify the impact of two approaches (directed and query‐based) to health information exchange () on potentially avoidable use of health care services.

Data Sources/Study Setting

Data on ambulatory care providers’ adoption of were merged with Medicare fee‐for‐service claims from 2008 to 2014. Providers were from 13 counties in New York served by the Rochester Regional Health Information Organization ().

Study Design

Linear regression models with provider and year fixed effects were used to estimate changes in the probability of utilization outcomes for Medicare beneficiaries attributed to providers adopting directed and/or query‐based compared with beneficiaries attributed to providers who had not adopted .

Data Collection

Providers’ adoption status was determined through Rochester registration records. and claims data were linked via National Provider Identifiers.

Principal Findings

Query‐based adoption was associated with a 0.2 percentage point reduction in the probability of an ambulatory care sensitive hospitalization and a 1.1 percentage point decrease in the likelihood of an unplanned readmission. Directed adoption was not associated with any outcome.


The Centers for Medicare & Medicaid Services’ () certification criteria includes requirements for directed , but not query‐based . Pending further research, certification criteria should place equal weight on facilitating query‐based and directed exchange.