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

描述(申请人提供)：住院患者的不良事件是灾难性的，对个人、医院和社会都是昂贵的。尽管十年来得到了广泛的关注和行动，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)的使用是一种很有前途的系统级举措，可以改善提供者的表现，促进跨学科交流，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。这项拟议的横断面研究将经验性地检查电子病历功能和利用率的水平及其与护理提供的关系，考虑到大量患者特征以及医院特征，包括护士人员配备和组织氛围的衡量标准。样本包括新泽西州72家急性护理医院的7000多名注册护士的2006年护士调查数据，以及同期住院的约100万名患者的出院数据。研究数据将来自五个来源，包括1)医疗成本和利用项目(HCUP)国家住院患者数据库(SID)，可从医疗研究和质量机构(AHRQ)获得，2)新泽西州卫生和老年服务部(NJDHSS)提供的医院特征数据，3)医疗信息和管理系统协会(HIMSS)Dorenfest研究所电子健康记录实施情况的数据库，4)医疗保险和医疗补助服务中心(CMS)的数据，来自医院消费者评估医疗服务提供者和系统调查(HCAHPS)的数据，以及5)新泽西州护士调查数据。值得关注的结果包括护理敏感的AHRQ患者安全指标(PSI)、住院时间、再次住院和患者满意度。分析方法将使用多重Logistic和普通最小二乘回归模型来估计EHR实施对护理提供和患者结果的影响，控制患者、护士和医院的特征。使用Huber-White三明治方差估计器和混合模型的稳健程序将被用于解释医院内患者的聚集。这项研究从几个方面阐述了AHRQ改善患者安全和医疗质量的目标。首先，这项研究的发现将为减少住院患者不良事件和提高患者满意度的基于技术的、多方面的方法提供信息。其次，通过全面计划发布的调查结果将为关键的医疗高管和政策制定者提供信息，让他们就宝贵的医疗资源做出更好的决策。这项研究将为提高新泽西州和全国患者护理的安全性和质量提供必要的证据。 与公共卫生相关：每年有数千名住院患者经历一次直接由医疗保健造成的不良事件。这项研究将确定电子健康记录的实施是否与护理提供的质量和住院患者的结果相关。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。

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.