National Impact of IT Investments on Hospital Quality

描述（由申请人提供）：拟议的研究旨在提供卫生信息技术（IT）投资对医院生产效率和质量的影响的国家评估。具体而言，我们将评估临床IT投资对医院质量和效率措施的边际影响，使用2000-2005年医疗保险住院人数的国家样本，以及HIMSS对医院IT投资的年度调查。我们将从对医院管理人员进行的有限数量的访谈中获得定性数据，以了解他们投资医疗信息技术的理由、动机和期望。利用技术医院生产的经济模型，我们将探讨以下研究目的：(1)评估医院使用IT系统与患者住院时间之间的关系；(2)确定医院使用临床IT系统与住院期间的医疗结果之间是否存在关系，以及在多大程度上存在关系。作为这两个目标的一部分，我们将研究患有多种合并症的患者对健康信息技术的反应是否与疾病负担较轻的患者不同。由于医院投资临床IT系统的决定可能不是随机的，因此在分析患者结果时控制这一点很重要。可能存在一些未观察到的与IT投资和护理提供相关的因素，这些因素会影响患者的结果，因此很难在横断面分析中分别识别IT投资影响和管理影响。为了解决这个问题，我们将在分析中使用工具变量估计器和多年的数据。先前的研究没有充分处理这一点，提出了关于准确性和普遍性的问题。在本次调查结束时，我们将报告医疗信息技术对医院效率和医疗结果的边际贡献。这项研究是明尼苏达大学、卡耐基梅隆大学和南卡罗来纳医科大学的研究人员共同努力的结果。

DESCRIPTION (provided by applicant): The proposed research seeks to provide a national evaluation of the impact of health information technology (IT) investments on hospital productive efficiency and quality. Specifically, we will evaluate the marginal impact of clinical IT investments on measures of hospital quality and efficiency, using a national sample of Medicare hospital admissions for 2000-2005, as well as the HIMSS annual survey of hospital IT investments. We will supplement this with qualitative data from a limited number of interviews with hospital administrators regarding their rationale, incentives and expectations for investing in health IT. Using an economic model of technical hospital production, we will address the following study aims: (1) To evaluate the relationship between a hospital's use of IT systems and patient length of stay; and (2) To identify whether and to what extent, there is a relationship between a hospital's use of clinical IT systems and medical outcomes during hospitalization. As part of both these aims, we will examine whether patients with multiple comorbidities respond differently to health IT than those with less illness burden. Since a hospital's decision to invest in clinical IT systems may not be random, it is important to control for this in an analysis of patient outcomes. There may be unobserved factors that are related to both IT investment and the provision of care that affect patient outcomes, making it difficult to separately identify the IT investment impact from the managerial effect in a cross-sectional analysis. To address this, we will use an instrumental variables estimator and multiple years of data in our analysis. Prior studies have not sufficiently dealt with this, raising questions about accuracy and generalizability. At the conclusion of this investigation, we will report on the marginal contribution of health IT to hospital efficiency and medical outcomes. This research represents a collaborative effort of investigators at the University of Minnesota, Carnegie Mellon University, and the Medical University of South Carolina.