Electronic Health Records and Clinical Decision Support Systems Impact on National Ambulatory Care Quality
Electronic Health Records and Clinical Decision Support Systems Impact on National Ambulatory Care Quality
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DOI：
10.1001/archinternmed.2010.527
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发表时间：
2011-05-23
影响因子：
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通讯作者：
Stafford, Randall S.
中科院分区：
文献类型：
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作者：
Romano, Max J.;Stafford, Randall S.
背景：美国门诊医生越来越多地使用电子健康记录（EHR）。他们可以通过临床决策支持（CDS）和基于电子指南的提醒和警报来改善临床护理。使用全国代表性的数据，我们测试的假设，更高的质量的护理将与EHRs和CDS.Methods：我们分析了255 402门诊病人访问非联邦办公室和医院的医生调查数据，从2005-2007年全国门诊医疗服务调查和全国医院门诊医疗服务调查。基于20个先前开发的质量指标，我们评估了EHR和CDS的关系，提供指南一致的护理使用多变量logistic regression.Results：电子健康记录中使用的估计1.1亿美元，每年美国患者访问的30%。这些EHR访视中有57%（占所有访视的17%）提供了临床决策支持。在西方和多医生环境中，EHR和CDS的使用比单独实践更有可能。在20个指标中，只有1个指标的质量在EHR访问中高于非EHR访问（高危成人的饮食咨询，调整后的比值比，1.65; 95%置信区间，1.21-2.26）。在EHR访视中，20项质量指标中只有1项显示，与无CDS的EHR访视相比，CDS访视的性能显著更好（低风险患者缺乏常规心电图排序，校正比值比为2.88; 95%置信区间为1.69-4.90）。有没有其他显着的质量differentiations.Conclusions：我们的研究结果表明，没有一致的EHR和CDS之间的关联，更好的质量。这些结果引起了人们对卫生信息技术从根本上改变门诊医疗质量的能力的关注。
Background: Electronic health records (EHRs) are increasingly used by US outpatient physicians. They could improve clinical care via clinical decision support (CDS) and electronic guideline-based reminders and alerts. Using nationally representative data, we tested the hypothesis that a higher quality of care would be associated with EHRs and CDS.Methods: We analyzed physician survey data on 255 402 ambulatory patient visits in nonfederal offices and hospitals from the 2005-2007 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Based on 20 previously developed quality indicators, we assessed the relationship of EHRs and CDS to the provision of guideline-concordant care using multivariable logistic regression.Results: Electronic health records were used in 30% of an estimated 1.1 billion annual US patient visits. Clinical decision support was present in 57% of these EHR visits (17% of all visits). The use of EHRs and CDS was more likely in the West and in multiphysician settings than in solo practices. In only 1 of 20 indicators was quality greater in EHR visits than in non-EHR visits (diet counseling in high-risk adults, adjusted odds ratio, 1.65; 95% confidence interval, 1.21-2.26). Among the EHR visits, only 1 of 20 quality indicators showed significantly better performance in visits with CDS compared with EHR visits without CDS (lack of routine electrocardiographic ordering in low-risk patients, adjusted odds ratio, 2.88; 95% confidence interval, 1.69-4.90). There were no other significant quality differences.Conclusions: Our findings indicate no consistent association between EHRs and CDS and better quality. These results raise concerns about the ability of health information technology to fundamentally alter outpatient care quality.