Comprehensive electronic medical record implementation levels not associated with 30-day all-cause readmissions within Medicare beneficiaries with heart failure.
Comprehensive electronic medical record implementation levels not associated with 30-day all-cause readmissions within Medicare beneficiaries with heart failure.
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综合电子病历实施水平与心力衰竭 Medicare 受益人 30 天全因再入院无关。
DOI：
10.4338/aci-2014-01-ra-0008
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发表时间：
2014
影响因子：
2.9
通讯作者：
W. Ketcherside
中科院分区：
文献类型：
--
作者：
M. E. Patterson;P. Marken;Y. Zhong;S. Simon;W. Ketcherside
背景：30天再入院的监管标准激励医院提高护理质量。实施全面的电子健康记录系统可能会通过改善出院时的药物核对来降低再入院率，这证明了住院患者电子病历除了提高安全性和减少错误之外的其他好处。目的：比较全面实施电子健康档案系统的医院与没有全面实施电子健康档案系统的医院出院的心力衰竭患者的30天全因再入院发生率。方法：本回顾性队列研究使用来自美国医院协会健康信息技术调查和医疗保险A部分索赔的数据来衡量医院EHR实施水平与受益人再入院之间的关系。在控制受益人健康状况和医院组织因素的情况下，多变量Cox回归估计了实施全面电子病历的医院与未实施全面电子病历的医院出院的受益人30天内全因再入院的风险比。倾向分数用于解释选择偏差。结果：30天全因再入院的心力衰竭患者比例分别为30%、29%和32%，分别来自有完整、部分和没有全面EHR系统的医院。从全面实施电子病历系统的医院出院的心力衰竭患者与没有全面实施电子病历系统的医院出院的心力衰竭患者相比，30天再入院发生率相当（HR = 0.97, 95% CI 0.73 - 1.3）。结论：实施全面的电子病历系统不一定能提高医院降低30天再入院率的能力。提高急症后护理的效率将需要住院和门诊提供者之间更多的信息系统协调。引用本文：Patterson ME， Marken P, Zhong Y, Simon SD, Ketcherside W.综合电子病历实施水平与30天心力衰竭医疗保险受益人的全因再入院无关。苹果临床杂志2014；5: 670-684 http://dx.doi.org/10.4338/ACI-2014-01-RA-0008
Summary Background: Regulatory standards for 30-day readmissions incentivize hospitals to improve quality of care. Implementing comprehensive electronic health record systems potentially decreases readmission rates by improving medication reconciliation at discharge, demonstrating the additional benefits of inpatient EHRs beyond improved safety and decreased errors. Objective: To compare 30-day all-cause readmission incidence rates within Medicare fee-for-service with heart failure discharged from hospitals with full implementation levels of comprehensive EHR systems versus those without. Methods: This retrospective cohort study uses data from the American Hospital Association Health IT survey and Medicare Part A claims to measure associations between hospital EHR implementation levels and beneficiary readmissions. Multivariable Cox regressions estimate the hazard ratio of 30-day all-cause readmissions within beneficiaries discharged from hospitals implementing comprehensive EHRs versus those without, controlling for beneficiary health status and hospital organizational factors. Propensity scores are used to account for selection bias. Results: The proportion of heart failure patients with 30-day all-cause readmissions was 30%, 29%, and 32% for those discharged from hospitals with full, some, and no comprehensive EHR systems. Heart failure patients discharged from hospitals with fully implemented comprehensive EHRs compared to those with no comprehensive EHR systems had equivalent 30-day readmission incidence rates (HR = 0.97, 95% CI 0.73 – 1.3) Conclusions: Implementation of comprehensive electronic health record systems does not necessarily improve a hospital’s ability to decrease 30-day readmission rates. Improving the efficiency of post-acute care will require more coordination of information systems between inpatient and ambulatory providers. Citation: Patterson ME, Marken P, Zhong Y, Simon SD, Ketcherside W. Comprehensive electronic medical record implementation levels not associated with 30-day all-cause readmissions within Medicare beneficiaries with heart failure. Appl Clin Inf 2014; 5: 670–684 http://dx.doi.org/10.4338/ACI-2014-01-RA-0008
影响因子：
120.7
作者：
Krumholz, Harlan M.;Lin, Zhenqiu;Keenan, Patricia S.;Chen, Jersey;Ross, Joseph S.;Drye, Elizabeth E.;Bernheim, Susannah M.;Wang, Yun;Bradley, Elizabeth H.;Han, Lein F.;Normand, Sharon-Lise T.
通讯作者：
Normand, Sharon-Lise T.
患有心力衰竭的老年人的医疗保健和药物费用以及使用情况。
DOI：
10.1016/j.amjmed.2003.11.016
发表时间：
2004
期刊：
The American journal of medicine.
影响因子：
--
作者：
Stroupe,KevinT;Teal,EvgeniaY;Weiner,Michael;Gradus-Pizlo,Irmina;Brater,DCraig;Murray,MichaelD
通讯作者：
Murray,MichaelD
影响因子：
120.7
作者：
BATES, DW;CULLEN, DJ;LEAPE, LL
通讯作者：
LEAPE, LL