Electronic Health Record Usability: Associations With Nurse and Patient Outcomes in Hospitals.
Electronic Health Record Usability: Associations With Nurse and Patient Outcomes in Hospitals.
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DOI：
10.1097/mlr.0000000000001536
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发表时间：
2021-07-01
期刊：
影响因子：
3
通讯作者：
Aiken LH
中科院分区：
文献类型：
--
作者：
Kutney-Lee A;Brooks Carthon M;Sloane DM;Bowles KH;McHugh MD;Aiken LH
电子健康记录(EHR)的可用性问题对护士和患者的福祉构成了新的威胁；然而，很少有大型研究检查这些关系。研究EHR可用性与护士工作(职业倦怠、工作不满和离职意向)和外科病人(住院死亡率和30天再入院)结果之间的关系。对关联的美国医院协会、州病人出院和护士调查数据进行了横断面分析。样本包括343家医院、1,281,848名外科病人和12,004名护士。Logistic回归模型被用来评估EHR可用性和结果之间的关系，考虑到EHR采用水平(全面的和基本的或更少的)和其他混杂因素前后的关系。在完全调整的模型中，与在电子病历可用性较好的医院工作的护士相比，在电子病历可用性较差的医院工作的护士发生职业倦怠[优势比(OR)=1.41；95%可信区间(CI)，1.21~1.64]、工作不满意(OR=1.61，95%CI，1.37~1.90)和离职意向(OR=1.31，95%CI，1.09~1.58)的几率显著增加。在EHR可用性较差的医院接受治疗的外科患者与在可用性较好的医院接受治疗的患者相比，住院死亡率(OR=1.21，95%CI，1.09-1.35)和再次住院30天(OR=1.06，95%CI，1.01-1.12)的风险显著增加。采用全面的电子健康记录与护士职业倦怠的发生有关(OR=1.14，95%CI，1.01~1.28)。使用可用性不佳的EHR系统与护士工作结果不良、外科患者死亡率和再入院的几率较高相关。对于护士工作和病人结局而言，电子病历的可用性可能比全面采用电子病历更重要。
Electronic health record (EHR) usability issues represent an emerging threat to the wellbeing of nurses and patients; however, few large studies have examined these relationships. To examine associations between EHR usability and nurse job (burnout, job dissatisfaction, and intention to leave) and surgical patient (inpatient mortality and 30-day readmission) outcomes. A cross-sectional analysis of linked American Hospital Association, state patient discharge, and nurse survey data was conducted. The sample included 343 hospitals, 1,281,848 surgical patients, and 12,004 nurses. Logistic regression models were used to assess relationships between EHR usability and outcomes, before and after accounting for EHR adoption level (comprehensive vs. basic or less) and other confounders. In fully adjusted models, nurses who worked in hospitals with poorer EHR usability had significantly higher odds of burnout [odds ratio (OR)=1.41; 95% confidence interval (CI), 1.21-1.64], job dissatisfaction (OR=1.61, 95% CI, 1.37-1.90) and intention to leave (OR=1.31, 95% CI, 1.09-1.58) compared to nurses working in hospitals with better usability. Surgical patients treated in hospitals with poorer EHR usability had significantly higher odds of inpatient mortality (OR=1.21, 95% CI, 1.09-1.35) and 30-day readmission (OR=1.06, 95% CI, 1.01-1.12) compared to patients in hospitals with better usability. Comprehensive EHR adoption was associated with higher odds of nurse burnout (OR=1.14, 95% CI, 1.01-1.28). Employing EHR systems with suboptimal usability was associated with higher odds of adverse nurse job outcomes and surgical patient mortality and readmission. EHR usability may be more important to nurse job and patient outcomes than comprehensive EHR adoption.