Effects of Electronic Health Record Adoption on Hospital Cardiac Risk-adjusted Mortality Rates - Patients with Acute Myocardial Infarction or Congestive Heart Failure Öffentlichkeit
Hung, Peiyin (2011)
Abstract
Background: The final rule from CMS for the meaningful
use of electronic health
records (EHR) leaves unanswered basic questions about how the
implementation of different
EHR subsystems and the sequence of the implementation influence
various treatment
outcomes.
Methods: This study examines the impact of five EHR
subsystems on risk-adjusted
mortality rates (RSMRs) in patients with AMI or CHF. 969
non-federal, acute care hospitals
in 12 states were extracted from the linked 2008 American Hospital
Association EHR Survey
and CMS Hospital Compare Database. Adjusting for major hospital
characteristics using least
squares regression and propensity scores, we analyzed the impact of
both EHR subsystem
adoptions and the number of adopted EHR subsystems (clinical
documentation, test results
viewing system, physician order entry, decision support, bar-code
system) on the outcomes of
AMI and CHF inpatients.
Results: Significant variation exists in the
implementation of EHR
subsystems across U.S. hospitals. The presence of an EHR in a
hospital resulted in significant
reductions in RSMRs for both AMI and CHF by as much as 0.59%.
Adopting an additional
subsystem resulted in reductions in AMI and CHF RSMRs; however,
optimal results were
achieved in AMI and CHF when hospitals fully adopted at least 3 and
5 subsystems,
respectively. Of all EHR subsystems, computerized physician order
entry is the most
significant.
Implications: Policies to encourage adoption of EHR
should emphasize
computerized physician order entry and consider the sequence of EHR
subsystem adoption in
hospitals.
Table of Contents
LIST OF TABLES. VI
LIST OF FIGURES. VII
LIST OF ABBREVIATIONS. VIII
INTRODUCTION.. 1
LITERATURE REVIEW... 2
Background and Overview.. 2
Prevalence of Electronic Health Record. 4
Electronic Health Record and Healthcare Quality. 5
Acute Myocardial Infarction & Congestive Heart Failure Mortality. 8
Previous Study Limitations. 10
METHODOLOGY.. 11
Study Design. 11
Dependent Variables. 15
Key Independent Variables. 15
Statistic Analysis. 19
RESULTS. 25
Descriptive Statistics. 25
Propensity Score Analysis. 31
Ordinal Least Squares Regression. 32
DISCUSSION.. 38
Study Implications. 38
Study Limitations. 41
Policy Implications. 43
Clinical Implications. 45
Future Research. 45
CONCLUSION.. 46
APPENDICES. 47
BIBLIOGRAPHY.. 59
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