Electronic Health Record Components and the Quality of Care
Electronic Health Record Components and the Quality of Care
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DOI：
10.1097/mlr.0b013e31817e18ae
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发表时间：
2008-12-01
期刊：
影响因子：
3
通讯作者：
Siu, Albert L.
中科院分区：
文献类型：
--
作者：
Keyhani, Salomeh;Hebert, Paul L.;Siu, Albert L.
背景：电子健康记录（EHR）已被推广为提高护理质量的重要工具。我们研究了EHR组件之间的关联，一个完整的EHR，和质量的care.Methods：从2005年全国门诊医疗调查和全国医院门诊医疗调查的数据，我们进行了一个横断面分析，所有访问与一个既定的初级保健提供者和检查之间的关联存在的EHR组件和：（1）血压控制;及（2）接受适当的慢性病治疗。我们研究了类似的协会完整的电子病历，我们定义为一个包括医生和护理笔记，电子提醒系统，计算机化的处方订单输入，测试结果，和计算机化的测试订单输入。我们构建了多变量模型来检验EHR成分与控制患者社会人口统计学、健康、医生实践和地理因素的每个结果之间的关联。结果：我们发现电子医生记录与血压控制或接受适当治疗之间没有关联，除了哮喘患者中的吸入性类固醇（调整后的比值比为2.86; 95%置信区间为1.12 - 7.32）。我们发现电子提醒系统与血压控制或接受适当治疗之间没有关联，但糖尿病合并高血压患者使用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂除外（比值比2.58; 95%置信区间，1.22 - 5.42）。我们发现电子医生笔记和任何质量指标之间没有联系。我们没有发现有一个完整的EHR和任何质量measures investigated.Conclusions之间的关系：我们发现血压控制，慢性疾病的管理，和特定的EHR组件之间没有一致的关联。未来的研究重点是如何实施和使用EHR，以及如何通过EHR整合护理，将提高我们对EHR对护理质量影响的理解。
Background: Electronic health records (EHRs) have been promoted as an important tool to improve quality of care. We examined the association between EHR components, a complete EHR, and the quality of care.Methods: Using data from the 2005 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, we conducted a cross-sectional analysis of all visits with an established primary care provider and examined the association between presence of EHR components and: (1) blood pressure control; and (2) receipt of appropriate therapy for chronic conditions. We examined similar associations for complete EHRs which we defined as one that includes physician and nursing notes, electronic reminder system, computerized prescription order entry, test results, and computerized test order entry. We constructed multivariate models to examine the association between EHR components and each outcome controlling for patient sociodemographic, health, physician practice, and geographic factors.Results: We found no association between electronic physician notes and blood pressure control or receipt of appropriate therapies, with the exception of inhaled steroids among asthmatics (adjusted odds ratio 2.86; 95% confidence interval, 1.12-7.32). We found no association between electronic reminder systems and blood pressure control or receipt of appropriate therapies, with the exception of angiotensin converting enzyme inhibitors or angiotensin receptor blockers in patients with diabetes with hypertension (odds ratio 2.58; 95% confidence interval, 1.22-5.42). We found no association between electronic physician notes and any measure of quality. We found no relationship between having a complete EHR and any of the quality measures investigated.Conclusions: We found no consistent association between blood pressure control, management of chronic conditions, and specific EHR components. Future research focusing on how an EHR is implemented and used and how care is integrated through an EHR will improve our understanding of the impact of EHRs on the quality of care.