Electronic Health Record Use, Work Environments & Patient Outcomes

 描述(由申请人提供)：电子健康记录(EHR)改善医疗保健质量和安全的巨大承诺尚未实现。住院患者--尤其是那些因普通外科手术入院的患者--继续面临更高的不良后果风险，包括死亡、并发症、再入院和不符合标准的护理。采用电子健康记录并没有带来广泛的护理改进的一个潜在原因是，管理者缺乏关于这些技术系统在什么情况下运行得最好的关键证据。组织理论文献表明，管理支持和组织氛围等制度特征对于技术等创新的成功实施至关重要。然而，在经验性医疗保健文献中，很少或根本没有注意到医院使用电子病历和临床患者结果之间的关系是否取决于更广泛的工作环境，特别是护士--医院中最大的直接护理提供者和电子病历使用者群体。此应用程序使用护士的报告来衡量与护士在组织中的参与度和资源充分性相关的工作环境的特征，以及人员配备水平和EHR效率评估。这项研究的目的不仅是确定电子病历的采用是否与更好的患者结局有关，而且还旨在确定电子病历的有效性是否取决于拥有支持专业护理实践的组织结构。我们希望发现，在环境更好、人员配备更好的医院接受治疗的患者将有更多的电子健康记录使用，对电子健康记录有效性的积极评估更多，患者结果也更好。我们还预计，在电子病历使用的广度和深度方面发生更显著的变化将在患者预后方面产生更大的改善，这两种变化可能取决于护士的工作环境和护士的配置。在护士在执业过程中得到支持、参与有关病人护理的机构决策并拥有足够的人员支持的医院，EHR技术的全部优势可能得到最好的实现。在社会技术系统理论的指导下，这项针对美国四大州数百家医院的研究将采用横断面和纵向面板方法，使用与美国医院协会年度调查信息技术(IT)补充资料相联系的EHR立法实施前后收集的独特护士调查数据，以及2006/2007和2015年收集的200多万外科患者的行政患者出院数据。将检查的患者结果包括：30天死亡率、抢救失败、再入院和AHRQ患者安全指标。鉴于信息技术的迅速普及，我们的发现可能会促进EHR系统的成功实施。这项研究是朝着更全面地了解电子病历系统在促进循证护理和改善患者、家庭和提供者之间的护理协调和沟通的预期目的方面发挥最佳作用的条件迈出的关键一步。

 DESCRIPTION (provided by applicant): The tremendous promise of electronic health records (EHR) to improve the quality and safety of healthcare has gone unrealized. Hospitalized patients- particularly those admitted for general surgical procedures- continue to face increased risk of adverse outcomes, including death, complications, readmissions and substandard care. One potential reason that EHR adoption has not resulted in widespread improvements in care is that administrators lack critical evidence regarding the context in which these technology systems function best. Organizational theory literature suggests that institutional characteristics such as managerial support and organizational climate are essential to the successful implementation of innovations, such as technology. Yet, there has been little to no attention in the empirical healthcare literature given to whether the relationship between EHR use and clinical patient outcomes in hospitals is conditional on the broader work environment, particularly of nurses- the largest group of direct care providers and EHR users in hospitals. This application uses nurses' reports to measure features of the work environment related to nurses' engagement in the organization and resource adequacy, in addition to staffing levels and evaluations of EHR effectiveness. The study aims to determine not only whether EHR adoption is related to better patient outcomes, but also whether EHR effectiveness hinges upon having an organizational structure that supports professional nursing practice. We expect to find that patients treated in hospitals with better environments and better staffing will have greater EHR use, more positive evaluations of EHR effectiveness, and better patient outcomes. We also expect that more pronounced changes in the breadth and depth of EHR use will produce greater improvements in patient outcomes, and that both changes may be conditional on nurse work environments and nurse staffing. The full advantage of EHR technology may be best realized in hospitals where nurses are supported in their practice, are involved in institutional decision-making regarding delivery of patient care, and have adequate staffing support. Guided by sociotechnical systems theory, this study of hundreds of hospitals in 4 large U.S. states will employ both cross-sectional and longitudinal panel methods using unique nurse survey data collected before and after implementation of EHR legislation linked with the American Hospital Association Annual Survey Information Technology (IT) Supplement, and administrative patient discharge data from over 2 million surgical patients collected in 2006/2007 and 2015. Patient outcomes that will be examined include: 30-day mortality, failure-to-rescue, readmission, and AHRQ patient safety indicators. Given the rapid diffusion of IT, our findings could improve successful implementation of EHR systems. This study is a critical step towards a more comprehensive understanding of the conditions under which EHR systems function best in their intended purpose of facilitating evidence-based care and improving care coordination and communication between patients, families, and providers.