Abstract
Health information technology, including electronic health records,
has the potential to improve healthcare quality and outcomes by
innovating healthcare delivery processes. This dissertation is
comprised of three essays investigating the impact of Electronic
Health Records (EHRs) on health services utilization and quality of
healthcare both in ambulatory and hospital care settings. The first
essay examines the impact of eight EHR components that map four
core EHR functionalities on the frequency of health behavior
counseling provided during primary care visits. This essay finds
that two functionalities, order entry and health information and
data, were independently associated with increases in the
probability of health behavior counseling service delivery. On the
other hand, decision support and results management were associated
with decreases in the provision of health behavior counseling
services when these components were used alone. However, using
these two functionalities with relevant complementary components
increases health counseling services. The second essay examines
differential impacts of EHRs on hospital-acquired adverse patient
safety events depending on intra-operability of an EHR system and
the degree of physician resistance. The main conclusion of this
essay is that a single source EHR system is associated with a
reduction in patient safety events. The third essay examines
whether EHRs enhance adherence to 3 core Surgical Care Improvement
Project (SCIP) infection-prevention process of care measures and
reduce postoperative infections. The results show that hospitals
with basic EHRs are more likely to adhere to SCIP
infection-prevention measures, and an increase in adherence rates
of one of the 3 core SCIP measures, timely start of antibiotics,
are associated with lower postoperative infection rates. However,
the results finds no significant mediation effect of SCIP process
of care measures on the association between EHRs and postoperative
infections, and no significant EHR effects on postoperative
infections.
Table of Contents
Chapter 1: Introduction 1.1 Background 2 1.2 Definitions 5 1.2.1
Electronic Health Record 5 1.2.2 Inter-operability and
Intra-operability of Health Information System 5 1.2.3 Health
Information Technology for Economic and Clinical Health Act 5 1.2.4
Patient Safety 5 1.3 Key Functionalities of an EHR System 6 1.4
Conceptual Framework 8 1.5 Aim and Scope 10 1.6 References 11
Chapter 2: Impact of Electronic Health Records on Delivery of
Health Behavior Counseling Services: The Role of Complementary
Functionalities 2.1 Background 16 2.2 Conceptual Framework 18 2.3
Literature Review 20 2.4 Methods 2.4.1 Data 22 2.4.2 Health
Behavior Counseling Services 23 2.4.3 EHR Adoption 23 2.4.4
Statistical Models 24 2.4.5 Confounding of EHR Adoption and Health
Behavior Counseling Services 25 2.5 Results 2.5.1 Descriptive
Statistics 26 2.5.2 Propsensity Score Matching 27 2.5.3 Adjusted
EHR Impact on Health Behavior Counseling Services 28 2.5.4
Sensitivity Analyses 29 2.6 Discussion 30 2.7 Conclusion 34 2.8
References 34 Chapter 3: The Impact of Electronic Health Records on
Hospital-Acquired Adverse Safety Events: Do Intra-operability and
Physician Support Matter? 3.1 Introduction 62 3.2 Background 3.2.1
Barriers to EHR Use 63 3.2.2 EHR Use and Patient Safety 64 3.3
Theoretical Framework 65 3.4 Literature 67 3.4.1 Compatibility of
EHR System and Staff Support 67 3.4.2 EHRs and Patient Safety 68
3.4.3 Contrubution of This Study 72 3.5 Methods 3.5.1 Data 73 3.5.2
Hospital-Acquired Adverse Patient Safety Events 74 3.5.3 Key
Explanatory Variables 74 3.5.3 Empirical Models 75 3.6 Results 77
3.6 Discussion and Conclusion 79 3.7 References 82 Chapter 4: The
Impact of Electronic Health Records on Adherence to
Infection-Prevention Process of Care Measures and Surgical
Infections 4.1 Background 100 4.2 Conceptual Framework 101 4.3
Literature Review 104 4.4 Methods 4.4.1 Data 106 4.4.2
Postoperative Infections 107 4.4.3 Core Surgical Care Improvement
Project (SCIP) Measures 108 4.4.4 Basic EHR Use 108 4.4.5 Empirical
Models 108 4.5 Results 108 4.6 Discussion and Conclusion 110 4.7
References 112 Chapter 5: Conclusion 5.1 Summary of Principal
Findings 125 5.1 Implication of Findings 126
About this Dissertation
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