{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T15:27:10Z","timestamp":1789658830518,"version":"4.0.1"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Clinical Informatics and Data Management Office and Quality Enhancement Research Initiative","award":["PEC 16-001"],"award-info":[{"award-number":["PEC 16-001"]}],"id":[{"id":"https:\/\/ror.org\/03cdz5d08","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Department of Veterans Affairs or the United States Government"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine whether a greater volume of health information exchange (HIE) between care delivery systems improves patient outcomes and whether effects differ between community care and Veterans Health Administration (VHA) direct care settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We used electronic health record data for all VHA enrollees from January 2022 to December 2023 (3144 medical center-months; 2.4 million patients per month). HIE volume, the number of unique patient-days with completed exchanges, was our key explanatory variable. Primary outcomes were 30-day readmissions, avoidable hospitalizations, and in-hospital mortality. We instrumented for HIE volume using each medical center\u2019s count of organizational exchange partners and estimated models overall and by care setting with medical center and month fixed effects and direct patient volume controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In community care, a 1-SD increase in HIE volume was associated with 4.07 fewer 30-day readmissions (95% CI, \u22124.62 to \u22123.51), 1.45 fewer avoidable hospitalizations (95% CI, \u22122.84 to \u22120.06), and 0.25 fewer inpatient deaths (95% CI, \u22120.44 to \u22120.06) per medical center per month. In VHA direct care, the same increase in HIE volume was associated with 7.07 additional readmissions (95% CI, 6.46-7.67) and 0.19 additional inpatient deaths (95% CI, 0.03-0.35), with no significant impact on avoidable hospitalizations (95% CI, \u22120.96 to 1.68).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Setting-specific effects may stem from asymmetric content (longitudinal histories outbound from VHA, episodic summaries inbound to VHA), asymmetric interfaces (modern community EHRs vs VHA\u2019s Joint Legacy Viewer), and HIE-enabled reclamation of community patients into VHA. More work is needed to disentangle these mechanisms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jamia\/ocag125","type":"journal-article","created":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T11:50:39Z","timestamp":1783770639000},"page":"1770-1779","source":"Crossref","is-referenced-by-count":0,"title":["Veteran health information exchange volume and 30-day readmissions, avoidable hospitalizations, and in-hospital mortality: evidence from community and Veterans Health Administration direct care"],"prefix":"10.1093","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7846-9983","authenticated-orcid":false,"given":"Abbie","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Health Law, Policy, and Management, Boston University School of Public Health , Boston, MA 02118,","place":["United States"]},{"name":"VA Boston Healthcare System Partnered Evidence-Based Policy Resource Center, , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Lipsey","sequence":"additional","affiliation":[{"name":"Department of Health Law, Policy, and Management, Boston University School of Public Health , Boston, MA 02118,","place":["United States"]},{"name":"VA Boston Healthcare System Partnered Evidence-Based Policy Resource Center, , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart","family":"Figueroa","sequence":"additional","affiliation":[{"name":"Department of Health Law, Policy, and Management, Boston University School of Public Health , Boston, MA 02118,","place":["United States"]},{"name":"VA Boston Healthcare System Partnered Evidence-Based Policy Resource Center, , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan E","family":"Price","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System Partnered Evidence-Based Policy Resource Center, , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Nebeker","sequence":"additional","affiliation":[{"name":"Informatics and Computing, Veterans Health Administration , Washington, DC,","place":["United States"]},{"name":"University of Utah School of Medicine , Salt Lake City, UT,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0667-9061","authenticated-orcid":false,"given":"Eric Chung Ren","family":"Pan","sequence":"additional","affiliation":[{"name":"Westat Inc , Rockville, MD,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8304-8602","authenticated-orcid":false,"given":"Kevin","family":"Griffith","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System Partnered Evidence-Based Policy Resource Center, , Boston, MA,","place":["United States"]},{"name":"Vanderbilt University Medical Center , Nashville, TN,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven D","family":"Pizer","sequence":"additional","affiliation":[{"name":"Department of Health Law, Policy, and Management, Boston University School of Public Health , Boston, MA 02118,","place":["United States"]},{"name":"VA Boston Healthcare System Partnered Evidence-Based Policy Resource Center, , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"2026091614321467600_ocag125-B1","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1136\/amiajnl-2014-002760","article-title":"The potential for community-based health information exchange systems to reduce hospital readmissions","volume":"22","author":"Vest","year":"2015","journal-title":"J Am Med Inform Assoc"},{"key":"2026091614321467600_ocag125-B2","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1007\/s11606-012-2092-7","article-title":"Does health information exchange reduce unnecessary neuroimaging and improve quality of headache care in the emergency department?","volume":"28","author":"Bailey","year":"2013","journal-title":"J Gen Intern Med"},{"key":"2026091614321467600_ocag125-B3","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1016\/j.ijmedinf.2015.05.008","article-title":"Can a health information exchange save healthcare costs? 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