Relationship Between Use of Electronic Health Record Features and Health Care Quality Results of a Statewide Survey
Relationship Between Use of Electronic Health Record Features and Health Care Quality Results of a Statewide Survey
复制标题
DOI：
10.1097/mlr.0b013e3181c16203
复制
发表时间：
2010-03-01
期刊：
影响因子：
3
通讯作者：
Bates, David W.
中科院分区：
文献类型：
--
作者：
Poon, Eric G.;Wright, Adam;Bates, David W.
背景：电子健康记录(EHR)被广泛视为支持提供高质量医疗保健的有用工具。然而，关于它们的有效性的证据是混合的，现有的研究通常认为电子病历的使用是一个二元因素，没有考虑特定的电子病历功能的可用性和使用。目的：评估电子病历的使用和特定的电子病历功能的使用与护理质量的关系。研究设计：2005年对马萨诸塞州的医生进行的全州邮寄调查。调查结果与医疗有效性数据和信息集(HEDIS)质量指标相关联，并估计了广义线性回归模型，以检验EHR的使用与特定EHR特征与质量指标之间的关联，并根据医生执业特征进行调整。对象：分层随机抽样1884名马萨诸塞州注册医生，其中1345人回答。其中，507人有HEDIS测量工具，并被纳入分析(测量仅适用于初级保健提供者)。测量：HEDIS质量测量的表现。结果：调查的应答率为71%。在任何HEDIS测量分组中，使用EHR作为二元因素和表现之间没有统计学上的显著关联。然而，在使用许多(但不是全部)特定的EHR特征和HEDIS测量组分数之间存在统计学上的显著关联。在问题清单、就诊记录和放射检查结果EHR特征以及与妇女健康、结肠癌筛查和癌症预防相关的质量措施方面，相关性最强。例如，使用问题列表功能的用户在女性健康、抑郁、结肠癌筛查和癌症预防措施方面表现更好，在HEDIS测量小组的分数上，问题列表用户的表现比不使用问题列表功能的用户高3.3%到9.6%(均在P<；0.05水平上显著)。然而，这些联系并不普遍。结论：与过去的研究一致，使用电子健康记录作为二元因素与质量测量的表现之间没有显著的关系。然而，初级保健医生对特定电子病历特征的可用性和使用与在某些质量指标上的较高表现相关。这些结果表明，为了最大限度地提高医疗保健质量，EHR的开发者、实施者和认证者应该把重点放在增加健壮的EHR系统的采用和特定功能的使用上，而不是简单地着眼于部署EHR而不考虑功能。
Background: Electronic health records (EHRs) are widely viewed as useful tools for supporting the provision of high quality healthcare. However, evidence regarding their effectiveness for this purpose is mixed, and existing studies have generally considered EHR usage a binary factor and have not considered the availability and use of specific EHR features.Objective: To assess the relationship between the use of an EHR and the use of specific EHR features with quality of care.Research Design: A statewide mail survey of physicians in Massachusetts conducted in 2005. The results of the survey were linked with Healthcare Effectiveness Data and Information Set (HEDIS) quality measures, and generalized linear regression models were estimated to examine the associations between the use of EHRs and specific EHR features with quality measures, adjusting for physician practice characteristics.Subjects: A stratified random sample of 1884 licensed physicians in Massachusetts, 1345 of whom responded. Of these, 507 had HEDIS measures available and were included in the analysis (measures are only available for primary care providers).Measure: Performance on HEDIS quality measures.Results: The survey had a response rate of 71%. There was no statistically significant association between use of an EHR as a binary factor and performance on any of the HEDIS measure groups. However, there were statistically significant associations between the use of many, but not all, specific EHR features and HEDIS measure group scores. The associations were strongest for the problem list, visit note and radiology test result EHR features and for quality measures relating to women's health, colon cancer screening, and cancer prevention. For example, users of problem list functionality performed better on women's health, depression, colon cancer screening, and cancer prevention measures, with problem list users outperforming nonusers by 3.3% to 9.6% points on HEDIS measure group scores (all significant at the P < 0.05 level). However, these associations were not universal.Conclusions: Consistent with past studies, there was no significant relationship between use of EHR as a binary factor and performance on quality measures. However, availability and use of specific EHR features by primary care physicians was associated with higher performance on certain quality measures. These results suggest that, to maximize health care quality, developers, implementers and certifiers of EHRs should focus on increasing the adoption of robust EHR systems and increasing the use of specific features rather than simply aiming to deploy an EHR regardless of functionality.