Hospital Adoption of Electronic Decision Support Tools for Preeclampsia Management.
Hospital Adoption of Electronic Decision Support Tools for Preeclampsia Management.
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DOI：
10.1097/qmh.0000000000000328
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发表时间：
2022-04-01
影响因子：
1.2
通讯作者：
Rodriguez HP
中科院分区：
文献类型：
--
作者：
Bui LN;Marshall C;Miller-Rosales C;Rodriguez HP
基于电子健康记录（EHR）的临床决策支持工具可以改善基于证据的子痫前期管理临床指南的使用，从而降低孕产妇死亡率和发病率。没有研究调查组织能力，使医院使用基于电子病历的决策支持工具来管理先兆子痫。探讨组织能力与医院采用基于电子病历的决策支持工具进行子痫前期管理的关系。2017年提供产科护理的医院的横断面分析。总共有739家医院响应了2017-2018年全国医疗保健组织和系统调查（NSHOS），并与2017年美国医院协会（AHA）年度调查数据库和地区卫生资源文件（AHRF）相关联。49个州共有425家提供产科护理的医院被纳入分析。主要结果是医院是否采用基于电子病历的临床决策支持工具进行子痫前期管理。作为预测因素评估的医院组织能力包括电子病历功能、循证临床治疗的采用、质量改进方法的使用以及分享最佳患者护理实践的传播过程。Logistic回归估计了医院组织能力与医院采用基于ehr的决策支持工具来管理子痫前期的关系，控制了医院结构和患者社会人口统计学特征。三分之二的医院（68%）采用基于电子病历的子痫前期决策支持工具，略多于一半（56%）的医院拥有单一电子病历系统。多变量回归结果表明，与混合使用电子病历和纸质系统的医院相比，使用单一电子病历系统的医院更有可能采用基于电子病历的子痫前期决策支持工具（17.4个百分点；95% CI， 1.9至33.0;P < 0.05）。与拥有多个电子病历的医院相比，平均而言，拥有单个电子病历的医院也更有可能采用这些工具，高出9.3个百分点，但差异无统计学意义（95% CI, - 1.3至19.9）。拥有更多流程来帮助传播最佳患者护理实践的医院也更有可能在子痫前期采用基于ehr的决策支持工具（传播流程每增加1个单位，95% CI为0.1至0.6,P < 0.01）。标准化的电子病历和传播证据的政策是医院的基础能力，可以帮助在大约三分之一尚未使用电子病历的美国医院中推进基于电子病历的决策支持工具对子痫前期管理的使用。
Electronic health record (EHR)–based clinical decision support tools can improve the use of evidence-based clinical guidelines for preeclampsia management that can reduce maternal mortality and morbidity. No study has investigated the organizational capabilities that enable hospitals to use EHR-based decision support tools to manage preeclampsia. To examine the association of organizational capabilities and hospital adoption of EHR-based decision support tools for preeclampsia management. Cross-sectional analyses of hospitals providing obstetric care in 2017. In total, 739 hospitals responded to the 2017-2018 National Survey of Healthcare Organizations and Systems (NSHOS) and were linked to the 2017 American Hospital Association (AHA) Annual Survey Database and the Area Health Resources File (AHRF). A total of 425 hospitals providing obstetric care across 49 states were included in the analysis. The main outcome was whether a hospital adopted EHR-based clinical decision support tools for preeclampsia management. Hospital organizational capabilities assessed as predictors include EHR functions, adoption of evidence-based clinical treatments, use of quality improvement methods, and dissemination processes to share best patient care practices. Logistic regression estimated the association of hospital organizational capabilities and hospital adoption of EHR-based decision support tools to manage preeclampsia, controlling for hospital structural and patient sociodemographic characteristics. Two-thirds of the hospitals (68%) adopted EHR-based decision support tools for preeclampsia, and slightly more than half (56%) of hospitals had a single EHR system. Multivariable regression results indicate that hospitals with a single EHR system were more likely to adopt EHR-based decision support tools for preeclampsia (17.4 percentage points; 95% CI, 1.9 to 33.0; P < .05) than hospitals with a mixture of EHR and paper-based systems. Compared with hospitals having multiple EHRs, on average, hospitals having a single EHR were also more likely to adopt the tools by 9.3 percentage points, but the difference was not statistically significant (95% CI, −1.3 to 19.9). Hospitals with more processes to aid dissemination of best patient care practices were also more likely to adopt EHR-based decision-support tools for preeclampsia (0.4 percentage points; 95% CI, 0.1 to 0.6, for every 1-unit increase in dissemination processes; P < .01). Standardized EHRs and policies to disseminate evidence are foundational hospital capabilities that can help advance the use of EHR-based decision support tools for preeclampsia management in the approximately one-third of US hospitals that still do not use them.