Effects of Electronic Health Record Adoption on Hospital Cardiac Risk-adjusted Mortality Rates - Patients with Acute Myocardial Infarction or Congestive Heart Failure 公开

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

About this Master's Thesis

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School	Rollins School of Public Health
Department	Health Policy and Management
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Health Care Management
关键词	risk-adjusted mortality rates acute myocardial infarction propensity score analysis congestive heart failure electronic health record
Committee Chair / Thesis Advisor	Howard, David H, Emory University
Committee Members	Gaydos, Laura, Emory University Becker, Edmund R, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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