Impact of Heath Information Technology on Delivery and Quality of Patient Care

健康信息技术对患者护理服务和质量的影响

• 批准号: 8465002
• 负责人: Amanda Jane Hessels
• 金额: $ 4.25万
• 依托单位: RUTGERS THE STATE UNIV OF NJ NEWARK
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2013-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8465002
• 关键词: Impact; Heath; Information; Technology; Delivery

DESCRIPTION (provided by applicant): Adverse events in hospitalized patients are catastrophic and costly to individuals, hospitals and society. Despite a decade of widespread attention and action, little progress has been made in improving patient safety and reducing preventable adverse events. The use of electronic health records (EHR) is one promising system-level initiative that may improve provider performance, interdisciplinary communication, reduce adverse patient events, improve the overall quality of patient care, and ultimately improve patient satisfaction with hospital care. This proposed cross-sectional study will empirically examine levels of EHR functionality and utilization and it's association with the delivery of nursing care, taking into account a large number of patient characteristics as well as hospital characteristics including measures of nurse staffing and organizational climate. The sample includes 2006 nurse survey data from more than 7,000 registered nurses working in 72 acute care hospitals in New Jersey, and patient discharge data from approximately one million patients hospitalized during the same time. Study data will be compiled from five sources including: 1) the Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) available from the Agency for Healthcare Research and Quality (AHRQ), 2) data on hospital characteristics from New Jersey Department of Health and Senior Services (NJDHSS), 3) Healthcare Information and Management Systems Society (HIMSS) Dorenfest Institute database of EHR implementation, 4) Centers for Medicare and Medicaid Services (CMS) data from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS), and 5) New Jersey nurse survey data. Outcomes of interest include nursing-sensitive AHRQ patient safety indicators (PSIs), length of stay, hospital readmission, and patient satisfaction. The analytic approach will use multiple logistic and ordinary least squares regression models to estimate the effects of EHR implementation on the delivery of nursing care and patient outcomes, controlling for characteristics of patients, nurses, and hospitals. Robust procedures with Huber-White sandwich variance estimators and mixed models will be used to account for the clustering of patients within hospitals. This study addresses AHRQ's goal to improve patient safety and health care quality in several ways. First, findings from this study wil inform a technologically based, multi- faceted approach to reducing inpatient adverse events and enhancing patient satisfaction. Second, findings disseminated through a comprehensive plan will inform key healthcare executives and policymakers to render better decisions regarding valuable healthcare resources. This study will provide the evidence necessary to improve the safety and quality of patient care in New Jersey and nationwide. PUBLIC HEALTH RELEVANCE: Each year thousands of hospitalized patients experience an adverse event that is a direct result of healthcare. This study will determine if the implementation of the electronic health record is associated with the quality of nursing care delivery and the outcomes of hospitalized patients. This will impact public health by generating knowledge that may be used to direct valuable resources that will have the greatest positive effect for hospitalized patients.

描述（由申请人提供）：住院患者的不良事件对个人、医院和社会来说是灾难性的，代价高昂。尽管十年来受到广泛关注和采取行动，但在改善患者安全和减少可预防的不良事件方面进展甚微。电子健康记录（EHR）的使用是一个有前途的系统级举措，可以提高提供者的绩效，跨学科的沟通，减少不良患者事件，提高患者护理的整体质量，并最终提高患者对医院护理的满意度。这项建议的横断面研究将实证研究水平的EHR的功能和利用率，它的关联提供护理，考虑到大量的病人的特点，以及医院的特点，包括护士的工作人员和组织气氛的措施。样本包括2006年在新泽西72家急性护理医院工作的7,000多名注册护士的护士调查数据，以及同期住院的约100万名患者的出院数据。研究数据将从五个来源汇编，包括：1）可从医疗保健研究和质量机构（AHRQ）获得的医疗保健成本和利用项目（HCUP）州住院病人数据库（SID），2）来自新泽西卫生和高级服务部（NJDHSS）的关于医院特征的数据，3）医疗保健信息和管理系统协会（HIMSS）的Dorenfest研究所EHR实施数据库，4）医疗保险和医疗补助服务中心（CMS）数据来自医院消费者对医疗保健提供者和系统的评估调查（HCAHPS），以及5）新泽西护士调查数据。关注的结果包括护理敏感的AHRQ患者安全指标（PSI），住院时间，再入院率和患者满意度。分析方法将使用多个逻辑和普通最小二乘回归模型来估计EHR实施对护理和患者结局的影响，控制患者，护士和医院的特征。将使用具有Huber-White三明治方差估计量和混合模型的稳健程序来解释医院内患者的聚类。这项研究解决了AHRQ的目标，以提高病人的安全和医疗保健质量在几个方面。首先，这项研究的结果将为减少住院不良事件和提高患者满意度提供一种基于技术的多方面方法。其次，通过全面计划传播的调查结果将为关键的医疗保健管理人员和政策制定者提供信息，以便就宝贵的医疗保健资源做出更好的决策。这项研究将提供必要的证据，以提高新泽西和全国范围内的病人护理的安全性和质量。 公共卫生相关性：每年有数千名住院患者经历医疗保健直接导致的不良事件。本研究将探讨电子健康档案的实施是否与护理服务的品质及住院病患的预后有相关性。这将通过产生可用于指导宝贵资源的知识来影响公共卫生，这些资源将对住院患者产生最大的积极影响。