Electronic Health Record Use, Work Environments & Patient Outcomes

电子健康记录的使用、工作环境

• 批准号: 9034256
• 负责人: Ann Kutney Lee
• 金额: $ 15.31万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9034256
• 关键词: Electronic; Health; Record; Use; Work

 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.

 描述（由申请人提供）：电子健康记录（EHR）在提高医疗保健质量和安全性方面的巨大承诺尚未实现。住院病人-特别是那些接受普通外科手术的病人-继续面临增加的不良后果风险，包括死亡、并发症、再次入院和不合格的护理。采用EHR并没有导致护理的广泛改善的一个潜在原因是，管理员缺乏关于这些技术系统最佳运行环境的关键证据。组织理论文献表明，管理支持和组织氛围等制度特征对于成功实施技术等创新至关重要。然而，在实证医疗文献中，很少有人关注医院中EHR使用与临床患者结局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EHR用户群体。该应用程序使用护士的报告来衡量与护士在组织中的参与和资源充足性相关的工作环境的特征，以及人员配备水平和EHR有效性的评估。这项研究的目的不仅是确定EHR的采用是否与更好的患者结局有关，而且还确定EHR的有效性是否取决于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EHR使用，对EHR有效性的评价更积极，患者的治疗效果也更好。我们还预计，EHR使用的广度和深度的更明显变化将使患者的预后得到更大的改善，这两种变化可能取决于护士的工作环境和护士的人员配备。EHR技术的充分优势可能在医院中得到最好的实现，护士在实践中得到支持，参与有关患者护理的机构决策，并有足够的人员支持。在社会技术系统理论的指导下，这项对美国4个大州数百家医院的研究将采用横截面和纵向面板方法，使用与美国医院协会年度调查信息技术（IT）补充有关的EHR立法实施前后收集的独特护士调查数据，以及2006/2007年和2015年收集的200多万手术患者的行政患者出院数据。将检查的患者结局包括：30天死亡率、抢救失败、再入院和AHRQ患者安全性指标。鉴于IT的快速传播，我们的研究结果可以改善EHR系统的成功实施。这项研究是更全面地了解EHR系统在其预期目的中发挥最佳作用的条件的关键一步，这些预期目的是促进循证护理，改善患者，家庭和提供者之间的护理协调和沟通。