Association of a clinical knowledge support system with improved patient safety, reduced complications and shorter length of stay among Medicare beneficiaries in acute care hospitals in the United States
Association of a clinical knowledge support system with improved patient safety, reduced complications and shorter length of stay among Medicare beneficiaries in acute care hospitals in the United States
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DOI：
10.1016/j.ijmedinf.2008.04.002
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发表时间：
2008-11-01
影响因子：
4.9
通讯作者：
Foster, David A.
中科院分区：
文献类型：
--
作者：
Bonis, Peter A.;Pickens, Gary T.;Foster, David A.
背景：电子临床知识支持系统减少了回答临床问题的障碍，但几乎没有证据表明它们是否对健康结果有影响。方法：我们将可在线访问 UpToDate (R) 的医院与汤姆森 100 家顶级医院数据库（汤姆森数据库）中包含的其他急症护理医院进行比较。汤姆森数据库中使用的指标在质量和效率等各种绩效维度上对医院进行区分。预先指定的结果包括风险调整死亡率、并发症、医疗保健研究机构和优质患者安全指标以及医疗保险受益人的住院时间。开发了线性回归模型，其中包括对医院区域、教学状况和出院量的调整。结果：访问 UpToDate (R) (n = 424) 的医院在患者安全风险调整措施 (P = 0.0163) 和并发症 (P = 0.0012) 方面的表现显着优于 Thomson 数据库中的其他医院 (n = 3091)，并且住院时间显着缩短（每次出院平均缩短 0.167 天，95% 置信区间） 0.081-0.252 天，P < 0.0001）。所有这些关联都与每家医院的 UpToDate (R) 使用量显着相关。 UpToDate (R) 医院和非 UpToDate (R) 医院之间的死亡率没有显着差异。 局限性：该研究是回顾性和观察性的，无法完全解释所纳入医院的其他特征，这些特征也可能与更好的健康结果相关。结论：电子临床知识支持系统 (UpToDate (R)) 与美国急症护理医院医疗保险受益人的健康结果改善和住院时间缩短相关。需要进行更多研究来澄清使用 UpToDate (R) 是否是绩效更好的标志、其独立原因，还是绩效较好医院其他质量改进特征的协同部分。 (C) 2008 Elsevier Ireland Ltd. 保留所有权利。
Background: Electronic clinical knowledge support systems have decreased barriers to answering clinical questions but there is little evidence as to whether they have an impact on health outcomes.Methods: We compared hospitals with online access to UpToDate (R), with other acute care hospitals included in the Thomson 100 Top Hospitals' Database (Thomson database). Metrics used in the Thomson database differentiate hospitals on a variety of performance dimensions such as quality and efficiency. Prespecified outcomes were risk-adjusted mortality, complications, the Agency of Healthcare Research and Quality Patient Safety Indicators, and hospital length of stay among Medicare beneficiaries. Linear regression models were developed that included adjustment for hospital region, teaching status, and discharge volume. Results: Hospitals with access to UpToDate (R) (n = 424) were associated with significantly better performance than other hospitals in the Thomson database (n = 3091) on risk-adjusted measures of patient safety (P = 0.0163) and complications (P = 0.0012) and had significantly shorter length of stay (by on average 0.167 days per discharge, 95% confidence interval 0.081-0.252 days, P < 0.0001). All of these associations correlated significantly with how much UpToDate (R) was used at each hospital. Mortality was not significantly different between UpToDate (R) and non-UpToDate (R) hospitals.Limitations: The study was retrospective and observational and could not fully account for additional features at the included hospitals that may also have been associated with better health outcomes.Conclusions: An electronic clinical knowledge support system (UpToDate (R)) was associated with improved health outcomes and shorter length of stay among Medicare beneficiaries in acute care hospitals in the United States. Additional studies are needed to clarify whether use of UpToDate (R) is a marker for the better performance, an independent cause of it, or a synergistic part of other quality improvement characteristics at better-performing hospitals. (C) 2008 Elsevier Ireland Ltd. All rights reserved.