Adverse inpatient outcomes during the transition to a new electronic health record system: observational study
Adverse inpatient outcomes during the transition to a new electronic health record system: observational study
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DOI：
10.1136/bmj.i3835
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发表时间：
2016-07-28
影响因子：
105.7
通讯作者：
Jena, Anupam B.
中科院分区：
文献类型：
--
作者：
Barnett, Michael L.;Mehrotra, Ateev;Jena, Anupam B.
目的：评估住院患者实施电子健康记录（EHR）与患者死亡率、再入院率和不良安全事件结局的短期相关性。设计：差异中差异分析的观察性研究。SettingMedicare，2011- 12。患者在2011-12年期间，17家研究医院收治了可验证的住院患者EHR实施“上线”日期的患者，和同一医院转诊区域的399家对照医院。主要结果指标出院后30天内全因再入院，入院后30天内全因死亡，和选定指标的患者安全性（PSI）定义的不良安全性事件-在实施EHR前90天和实施EHR后90天，在这些医院之一住院的Medicare受益人中的90个综合指标（n=28 235和26 453次入院），与同一医院转诊区域的所有同期入院的对照组（n=284 632和276 513次入院）进行比较。分析调整受益人的社会人口学和临床characteristics.ResultsBefore和after实施，入院的特点是相似的研究和对照医院。在研究医院中，实施EHR后，未校正的30天死亡率（6.74%至7.15%，P=0.06）和不良安全事件发生率（每1000例住院患者10.5至11.4起事件，P=0.34）没有显著变化。实施后30天再入院率从19.9%下降至19.0%（P=0.02）。然而，在差异-无差异分析中，实施前和实施后期间的任何结果都没有显著变化结论尽管在急性过渡期实施EHR可能会对患者护理产生不利影响，但我们没有发现这种实施与短期住院死亡率，不良安全事件，或在美国17家医院的医疗保险人群中重新入院。
OBJECTIVETo assess the short term association of inpatient implementation of electronic health records (EHRs) with patient outcomes of mortality, readmissions, and adverse safety events.DesignObservational study with difference-in-differences analysis.SettingMedicare, 2011-12.ParticipantsPatients admitted to 17 study hospitals with a verifiable "go live" date for implementation of inpatient EHRs during 2011-12, and 399 control hospitals in the same hospital referral region.Main outcome measuresAll cause readmission within 30 days of discharge, all cause mortality within 30 days of admission, and adverse safety events as defined by the patient safety for selected indicators (PSI)-90 composite measure among Medicare beneficiaries admitted to one of these hospitals 90 days before and 90 days after implementation of the EHRs (n=28 235 and 26 453 admissions), compared with the control group of all contemporaneous admissions to hospitals in the same hospital referral region (n=284 632 and 276 513 admissions). Analyses were adjusted for beneficiaries' sociodemographic and clinical characteristics.ResultsBefore and after implementation, characteristics of admissions were similar in both study and control hospitals. Among study hospitals, unadjusted 30 day mortality (6.74% to 7.15%, P=0.06) and adverse safety event rates (10.5 to 11.4 events per 1000 admissions, P=0.34) did not significantly change after implementation of EHRs. There was an unadjusted decrease in 30 day readmission rates, from 19.9% to 19.0% post-implementation (P=0.02). In difference-indifferences analysis, however, there was no significant change in any outcome between pre-implementation and post-implementation periods (all P >= 0.13).ConclusionsDespite concerns that implementation of EHRs might adversely impact patient care during the acute transition period, we found no overall negative association of such implementation on short term inpatient mortality, adverse safety events, or readmissions in the Medicare population across 17 US hospitals.