Accountable care organization hospitals differ in health IT capabilities.

OBJECTIVES The aim of this study was to evaluate health information technology (IT) adoption in hospitals participating in accountable care organizations (ACOs) and compare this adoption to non-ACO hospitals. STUDY DESIGN A cross-sectional sample of US nonfederal, acute care hospitals with data from 3 matched sources: the 2013 American Hospital Association (AHA) Annual Survey, the 2013 AHA Survey of Care Systems and Payments (CSP), and the 2014 AHA Information Technology Supplement. METHODS To compare health IT adoption in ACO- and non-ACO hospitals, we created measures of Meaningful Use (MU) Stage 1 and Stage 2 core and menu criteria, patient engagement-oriented health IT, and health information exchange (HIE) participation. Adoption was compared using both naïve and multivariate logit models. RESULTS Of the 393 ACO hospitals and 810 non-ACO hospitals, a greater percentage of ACO hospitals were capable of meeting MU Stage 1 (50.9% vs 41.6%; P < .01) and Stage 2 (7.6% vs 4.8%; P < .05), having patient engagement health IT (39.8% vs 15.2%; P < .001), and participating in HIE (49.0% vs 30.1%; P < .001). In adjusted models, no difference was found between ACO and non-ACO hospital ability to meet MU Stage 1 or Stage 2, but ACO hospitals were more likely to have patient engagement health IT (odds ratio (OR), 2.20; 95% CI, 1.59-3.04) and be HIE participants (OR, 1.41; 95% CI, 1.03-1.92). CONCLUSIONS ACO-participating hospitals appear to be focused more on adopting health IT that aligns with broader strategic goals rather than those that achieve MU. Aligning adoption with quality and payment reform may be a productive path forward to encourage hospital health IT adoption behavior.

目标 本研究旨在评估参与 accountable care organizations（ACO，责任医疗组织）的医院对健康信息技术（IT）的采用情况，并将其与非ACO医院的采用情况进行比较。 研究设计 对美国非联邦的急性护理医院进行横断面抽样，数据来自3个匹配的数据源：2013年美国医院协会（AHA）年度调查、2013年美国医院协会护理系统与支付调查（CSP）以及2014年美国医院协会信息技术补充资料。 方法 为了比较ACO医院和非ACO医院对健康IT的采用情况，我们制定了有意义使用（MU）第一阶段和第二阶段核心及菜单标准、以患者参与为导向的健康IT以及健康信息交换（HIE）参与的衡量指标。采用了简单和多元逻辑模型对采用情况进行比较。 结果 在393家ACO医院和810家非ACO医院中，能够满足MU第一阶段（50.9%对41.6%；P <.01）和第二阶段（7.6%对4.8%；P <.05）、拥有患者参与健康IT（39.8%对15.2%；P <.001）以及参与HIE（49.0%对30.1%；P <.001）的ACO医院比例更高。在调整后的模型中，ACO医院和非ACO医院在满足MU第一阶段或第二阶段的能力方面没有差异，但ACO医院更有可能拥有患者参与健康IT（优势比（OR），2.20；95%置信区间，1.59 - 3.04）并且是HIE参与者（OR，1.41；95%置信区间，1.03 - 1.92）。 结论 参与ACO的医院似乎更注重采用符合更广泛战略目标的健康IT，而非那些实现MU的IT。使采用情况与质量和支付改革相匹配可能是鼓励医院健康IT采用行为的一条有效途径。