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Bogale TN, Derseh L, Abraham L, Willems H, Metzger J, Abere B, Tilaye M, Hailegeberel T, Bekele TA. Effect of electronic records on mortality among patients in hospital and primary healthcare settings: a systematic review and meta-analyses. Front Digit Health 2024; 6:1377826. [PMID: 38988733 PMCID: PMC11233798 DOI: 10.3389/fdgth.2024.1377826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 06/13/2024] [Indexed: 07/12/2024] Open
Abstract
Background Electronic medical records or electronic health records, collectively called electronic records, have significantly transformed the healthcare system and service provision in our world. Despite a number of primary studies on the subject, reports are inconsistent and contradictory about the effects of electronic records on mortality. Therefore, this review examined the effect of electronic records on mortality. Methods The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guideline. Six databases: PubMed, EMBASE, Scopus, CINAHL, Cochrane Library, and Google Scholar, were searched from February 20 to October 25, 2023. Studies that assessed the effect of electronic records on mortality and were published between 1998 and 2022 were included. Joanna Briggs Institute quality appraisal tool was used to assess the methodological quality of the studies. Narrative synthesis was performed to identify patterns across studies. Meta-analysis was conducted using fixed effect and random-effects models to estimate the pooled effect of electronic records on mortality. Funnel plot and Egger's regression test were used to assess for publication bias. Results Fifty-four papers were found eligible for the systematic review, of which 42 were included in the meta-analyses. Of the 32 studies that assessed the effect of electronic health record on mortality, eight (25.00%) reported a statistically significant reduction in mortality, 22 (68.75%) did not show a statistically significant difference, and two (6.25%) studies reported an increased risk of mortality. Similarly, among the 22 studies that determined the effect of electronic medical record on mortality, 12 (54.55%) reported a statistically significant reduction in mortality, and ten (45.45%) studies didn't show a statistically significant difference. The fixed effect and random effects on mortality were OR = 0.95 (95% CI: 0.93-0.97) and OR = 0.94 (95% CI: 0.89-0.99), respectively. The associated I-squared was 61.5%. Statistical tests indicated that there was no significant publication bias among the studies included in the meta-analysis. Conclusion Despite some heterogeneity among the studies, the review indicated that the implementation of electronic records in inpatient, specialized and intensive care units, and primary healthcare facilities seems to result in a statistically significant reduction in mortality. Maturity level and specific features may have played important roles. Systematic Review Registration PROSPERO (CRD42023437257).
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Affiliation(s)
| | | | - Loko Abraham
- John Snow Research and Training Institute, Inc. (JSI), Addis Ababa, Ethiopia
| | - Herman Willems
- John Snow Research and Training Institute, Inc. (JSI), Boston, MA, United States
| | - Jonathan Metzger
- John Snow Research and Training Institute, Inc. (JSI), Washington, DC, United States
| | - Biruhtesfa Abere
- John Snow Research and Training Institute, Inc. (JSI), Addis Ababa, Ethiopia
| | - Mesfin Tilaye
- United State Agency for International Development, Addis Ababa, Ethiopia
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Li M, Ji YG, Yang ZQ, Xie HZ. Development of humanistic nursing practice guidelines for stroke patients. Front Public Health 2022; 10:915472. [PMID: 36016905 PMCID: PMC9395746 DOI: 10.3389/fpubh.2022.915472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/15/2022] [Indexed: 01/22/2023] Open
Abstract
Purpose To construct humanistic nursing practice guidelines suitable for stroke patients. Design This study was a development and validation study of guidelines using multiple methods, including literature review, qualitative research, questionnaire survey, thematic discussion, and Delphi expert consultation. Methods Twenty-five experts from seven provinces and municipalities in China were interviewed over two rounds from December 2020 to February 2021. The first-level index was scored for importance and rationality, while the second-level index was scored for importance and feasibility using a five-point Likert scale. Delphi data was collected via a paper version of the questionnaire. The coefficients of variation and coordination were used to represent the degree of dispersion of expert opinions. Findings In the two rounds of letter consultation, the questionnaire's recovery and effective rates were both 100%, while the opinion submission rates of the two rounds were 84 and 52%, respectively. Moreover, the expert authority coefficient was 0.91, and the coordination coefficients of expert opinions in the first round were as follows: importance of 0.03 and rationality of 0.07 for the first-level index; importance of 0.09 and feasibility of 0.11 for the secondary index. In round two, the coordination coefficients of expert opinions were as follows: importance of 0.04 and rationality of 0.05 for the first-level indicators; importance of 0.12 and feasibility of 0.10 for the secondary index. The results for the secondary index were P < 0.001 for the two rounds. The humanistic nursing practice guidelines for stroke patients that were ultimately formed included five first-level indicators (physiological care, safety care, emotional care, dignity care, and rehabilitation needs) and 46 s-level indicators. Conclusion Our results show that the "Practice Guidelines for Humanistic Nursing for Stroke" established by experts adopts Maslow's hierarchy of needs as its structural framework. It meets people's basic needs and can provide a reference for the construction of a humanistic nursing specialty practice for stroke patients. Clinical relevance Humanistic nursing guidelines for stroke could provide a reference for the construction of humanistic nursing practice in the stroke specialty. Clinical resources Copeptin and long-term risk of recurrent vascular events after transient ischemic attack and ischemic stroke: population-based study https://pubmed.ncbi.nlm.nih.gov/26451023/. Effectiveness and usage of a decision support system to improve stroke prevention in general practice: a cluster randomized controlled trial https://pubmed.ncbi.nlm.nih.gov/28245247/. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association https://pubmed.ncbi.nlm.nih.gov/27145936/.
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Affiliation(s)
- Min Li
- Department of Trauma Surgery, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Yu-gui Ji
- Department of Neurosurgery, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Zi-qing Yang
- Department of Health Medicine, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Hong-zhen Xie
- Department of Health Medicine, General Hospital of Southern Theatre Command, Guangzhou, China,*Correspondence: Hong-zhen Xie
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Uslu A, Stausberg J. Value of the Electronic Medical Record for Hospital Care: Update From the Literature. J Med Internet Res 2021; 23:e26323. [PMID: 34941544 PMCID: PMC8738989 DOI: 10.2196/26323] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/27/2021] [Accepted: 10/08/2021] [Indexed: 12/03/2022] Open
Abstract
Background Electronic records could improve quality and efficiency of health care. National and international bodies propagate this belief worldwide. However, the evidence base concerning the effects and advantages of electronic records is questionable. The outcome of health care systems is influenced by many components, making assertions about specific types of interventions difficult. Moreover, electronic records itself constitute a complex intervention offering several functions with possibly positive as well as negative effects on the outcome of health care systems. Objective The aim of this review is to summarize empirical studies about the value of electronic medical records (EMRs) for hospital care published between 2010 and spring 2019. Methods The authors adopted their method from a series of literature reviews. The literature search was performed on MEDLINE with “Medical Record System, Computerized” as the essential keyword. The selection process comprised 2 phases looking for a consent of both authors. Starting with 1345 references, 23 were finally included in the review. The evaluation combined a scoring of the studies’ quality, a description of data sources in case of secondary data analyses, and a qualitative assessment of the publications’ conclusions concerning the medical record’s impact on quality and efficiency of health care. Results The majority of the studies stemmed from the United States (19/23, 83%). Mostly, the studies used publicly available data (“secondary data studies”; 17/23, 74%). A total of 18 studies analyzed the effect of an EMR on the quality of health care (78%), 16 the effect on the efficiency of health care (70%). The primary data studies achieved a mean score of 4.3 (SD 1.37; theoretical maximum 10); the secondary data studies a mean score of 7.1 (SD 1.26; theoretical maximum 9). From the primary data studies, 2 demonstrated a reduction of costs. There was not one study that failed to demonstrate a positive effect on the quality of health care. Overall, 9/16 respective studies showed a reduction of costs (56%); 14/18 studies showed an increase of health care quality (78%); the remaining 4 studies missed explicit information about the proposed positive effect. Conclusions This review revealed a clear evidence about the value of EMRs. In addition to an awesome majority of economic advantages, the review also showed improvements in quality of care by all respective studies. The use of secondary data studies has prevailed over primary data studies in the meantime. Future work could focus on specific aspects of electronic records to guide their implementation and operation.
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Affiliation(s)
- Aykut Uslu
- USLU Medizininformatik, Düsseldorf, Germany
| | - Jürgen Stausberg
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Maldonado JA, Marcos M, Fernández-Breis JT, Giménez-Solano VM, Legaz-García MDC, Martínez-Salvador B. CLIN-IK-LINKS: A platform for the design and execution of clinical data transformation and reasoning workflows. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 197:105616. [PMID: 32629294 DOI: 10.1016/j.cmpb.2020.105616] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Effective sharing and reuse of Electronic Health Records (EHR) requires technological solutions which deal with different representations and different models of data. This includes information models, domain models and, ideally, inference models, which enable clinical decision support based on a knowledge base and facts. Our goal is to develop a framework to support EHR interoperability based on transformation and reasoning services intended for clinical data and knowledge. METHODS Our framework is based on workflows whose primary components are reusable mappings. Key features are an integrated representation, storage, and exploitation of different types of mappings for clinical data transformation purposes, as well as the support for the discovery of new workflows. The current framework supports mappings which take advantage of the best features of EHR standards and ontologies. Our proposal is based on our previous results and experience working with both technological infrastructures. RESULTS We have implemented CLIN-IK-LINKS, a web-based platform that enables users to create, modify and delete mappings as well as to define and execute workflows. The platform has been applied in two use cases: semantic publishing of clinical laboratory test results; and implementation of two colorectal cancer screening protocols. Real data have been used in both use cases. CONCLUSIONS The CLIN-IK-LINKS platform allows the composition and execution of clinical data transformation workflows to convert EHR data into EHR and/or semantic web standards. Having proved its usefulness to implement clinical data transformation applications of interest, CLIN-IK-LINKS can be regarded as a valuable contribution to improve the semantic interoperability of EHR systems.
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Affiliation(s)
| | - Mar Marcos
- Department of Computer Engineering and Science, Universitat Jaume I, Spain
| | | | | | - María Del Carmen Legaz-García
- Departamento de Informática y Sistemas, Universidad de Murcia, IMIB-Arrixaca, Spain; Fundación para la Formación e Investigación Sanitarias de la Región de Murcia, IMIB-Arrixaca, Spain
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Pandya A, Soeteman DI, Gupta A, Kamel H, Mushlin AI, Rosenthal MB. Can Pay-for Performance Incentive Levels be Determined Using a Cost-Effectiveness Framework? Circ Cardiovasc Qual Outcomes 2020; 13:e006492. [PMID: 32615799 PMCID: PMC7375940 DOI: 10.1161/circoutcomes.120.006492] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Healthcare payers in the United States are increasingly tying provider payments to quality and value using pay-for-performance policies. Cost-effectiveness analysis quantifies value in healthcare but is not currently used to design or prioritize pay-for-performance strategies or metrics. Acute ischemic stroke care provides a useful application to demonstrate how simulation modeling can be used to determine cost-effective levels of financial incentives used in pay-for-performance policies and associated challenges with this approach. METHODS AND RESULTS Our framework requires a simulation model that can estimate quality-adjusted life years and costs resulting from improvements in a quality metric. A monetary level of incentives can then be back-calculated using the lifetime discounted quality-adjusted life year (which includes effectiveness of quality improvement) and cost (which includes incentive payments and cost offsets from quality improvements) outputs from the model. We applied this framework to an acute ischemic stroke microsimulation model to calculate the difference in population-level net monetary benefit (willingness-to-pay of $50 000 to $150 000/quality-adjusted life year) accrued under current Medicare policy (stroke payment not adjusted for performance) compared with various hypothetical pay-for-performance policies. Performance measurement was based on time-to-thrombolytic treatment with tPA (tissue-type plasminogen activator). Compared with current payment, equivalent population-level net monetary benefit was achieved in pay-for-performance policies with 10-minute door-to-needle time reductions (5057 more acute ischemic stroke cases/y in the 0-3-hour window) incentivized by increasing tPA payment by as much as 18% to 44% depending on willingness-to-pay for health. CONCLUSIONS Cost-effectiveness modeling can be used to determine the upper bound of financial incentives used in pay-for-performance policies, although currently, this approach is limited due to data requirements and modeling assumptions. For tPA payments in acute ischemic stroke, our model-based results suggest financial incentives leading to a 10-minute decrease in door-to-needle time should be implemented but not exceed 18% to 44% of current tPA payment. In general, the optimal level of financial incentives will depend on willingness-to-pay for health and other modeling assumptions around parameter uncertainty and the relationship between quality improvements and long-run quality-adjusted life expectancy and costs.
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Affiliation(s)
- Ankur Pandya
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Djøra I. Soeteman
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Ajay Gupta
- Department of Radiology, Weill Cornell Medicine, New York, NY
| | - Hooman Kamel
- Department of Neurology and Neuroscience, Weill Cornell Medicine, New York, NY, USA
| | - Alvin I. Mushlin
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Meredith B. Rosenthal
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
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Abstract
Limited research exists which aids in structuring health IT contracts in an era of performance-based payments. We provide an assessment of common approaches to contracting and measuring of performance in practice. We conducted a review of existing literature and compliment this approach with a survey of healthcare professionals directly involved with health IT systems to further understand and classify current approaches. We identified architypes for structuring healthcare IT performance contracts to include: (1) internal operations, (2) external evaluation and (3) joint agreement for the delivery of value-based care.
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Affiliation(s)
- Thomas R Martin
- a St. Joseph's University Department of Health Services , Philadelphia , PA , USA
| | - Hamlet Gasoyan
- b Department of Health Services Administration and Policy , College of Public Health, Temple University , Philadelphia , PA , USA
| | - David J Wierz
- a St. Joseph's University Department of Health Services , Philadelphia , PA , USA
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Kitzman P, Wolfe M, Elkins K, Fraser JF, Grupke SL, Dobbs MR. The Kentucky Appalachian Stroke Registry (KApSR). J Stroke Cerebrovasc Dis 2018; 27:900-907. [PMID: 29269220 DOI: 10.1016/j.jstrokecerebrovasdis.2017.10.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/25/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The population of rural Kentucky and West Virginia has a disproportionately high incidence of stroke and stroke risk factors. The Kentucky Appalachian Stroke Registry (KApSR) is a novel registry of stroke patients developed to collect demographic and clinical data in real time from these patients' electronic health records. OBJECTIVE We describe the development of this novel registry and test it for ability to provide the information necessary to identify care gaps and direct clinical management. METHODS The KApSR was developed as described in this article. To assess utility in patient care, we developed a "Diabetes Quality Assurance Dashboard" by cross-referencing patients in the registry with a diagnosis of ischemic cerebrovascular disease with patients that were tested for hemoglobin A1c (HbA1c) levels, patients with HbA1c levels diagnostic for diabetes mellitus (DM), and patients with an elevated HbA1c that were formally diagnosed with DM. RESULTS For the 1008 patients treated for ischemic cerebrovascular disease in the year studied, 859 (85%) had their HbA1c tested. Of those, 281 had levels of 6.5 or greater, although only 261 (93%) were discharged with a formal diagnosis of DM. CONCLUSIONS The KApSR has practical value as a tool to assess a large population of patients quickly for care quality and for research purposes.
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Affiliation(s)
- Patrick Kitzman
- College of Health Sciences, University of Kentucky, Lexington, Kentucky; HealthCare Stroke Network, Norton Healthcare/UK, Lexington, Kentucky
| | - Marc Wolfe
- College of Health Sciences, University of Kentucky, Lexington, Kentucky; HealthCare Stroke Network, Norton Healthcare/UK, Lexington, Kentucky
| | - Kelley Elkins
- HealthCare Stroke Network, Norton Healthcare/UK, Lexington, Kentucky
| | - Justin F Fraser
- Department of Neurology, University of Kentucky, Lexington, Kentucky; Department of Neurological Surgery, University of Kentucky, Lexington, Kentucky; Department of Radiology, University of Kentucky, Lexington, Kentucky; Department of Anatomy and Neurobiology, University of Kentucky, Lexington, Kentucky
| | - Stephen L Grupke
- Department of Neurological Surgery, University of Kentucky, Lexington, Kentucky
| | - Michael R Dobbs
- HealthCare Stroke Network, Norton Healthcare/UK, Lexington, Kentucky; Department of Neurology, University of Kentucky, Lexington, Kentucky.
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Levkovich BJ, Bingham G, Jones D, Kirkpatrick CM, Cooper DJJ, Dooley MJ. Understanding how medications contribute to clinical deterioration and are used in rapid response systems: A comprehensive scoping review. Aust Crit Care 2018; 32:256-272. [PMID: 30005938 DOI: 10.1016/j.aucc.2018.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 05/23/2018] [Accepted: 05/29/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In hospitals, rapid response systems (RRSs) identify patients who deteriorate and provide critical care at their bedsides to stabilise and escalate care. Medications, including oral and parenteral pharmaceutical preparations, are the most common intervention for hospitalised patients and the most common cause of harm. This connection between clinical deterioration and medication safety is poorly understood. OBJECTIVES To inform improvements in prevention and management of clinical deterioration, this review aimed to examine how medications contributed to clinical deterioration and how medications were used in RRSs. REVIEW METHODS A scoping review was undertaken of medication data reported in studies of clinical deterioration or RRSs in diverse hospital settings between 2005 and 2017. Bibliographic database searches used permutations of "rapid response system," "medical emergency team," and keyword searching with medication-related terms. Independent selection, quality assessment, and data extraction informed mapping against four medication themes: causes of deterioration, predictors of deterioration, RRS use, and management. RESULTS Thirty articles were reviewed. Quality was low: limited by small samples, observational, single-centre designs and few primary medication-related outcomes. Adverse drug reactions and potentially preventable medication errors, involving sedatives, analgesics, and cardiovascular agents, contributed to clinical deterioration. While sparsely reported, outcomes included death and escalation of care. In children, administration of antibiotics or nebulised medications appeared to predict subsequent deterioration. Cardiovascular medications, sedatives, and analgesics commonly were used to manage deterioration but further detail was lacking. Despite reported potential for patient harm, evaluation of medication management systems was limited. CONCLUSIONS Medications contributed to potentially preventable clinical deterioration, with considerable harm, and were common interventions for its management. When assessing deteriorating patients or caring for patients who require escalation to critical care, clinicians should consider medication errors and adverse reactions. Studies with more specific medication-related, patient-centred end points could reduce medication-related deterioration and refine RRS medication use and management.
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Affiliation(s)
- Bianca J Levkovich
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Australia and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia; Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia.
| | - Gordon Bingham
- Intensive Care Unit, Alfred Health, Melbourne, Victoria, Australia.
| | - Daryl Jones
- Australia and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia; Intensive Care Unit, The Austin Hospital, Heidelberg, Victoria, Australia.
| | - Carl M Kirkpatrick
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
| | - D J Jamie Cooper
- Australia and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia; Intensive Care Unit, Alfred Health, Melbourne, Victoria, Australia.
| | - Michael J Dooley
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia.
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Brice YN, Joynt KE, Tompkins CP, Ritter GA. Meaningful Use and Hospital Performance on Post-Acute Utilization Indicators. Health Serv Res 2018; 53:803-823. [PMID: 28255995 PMCID: PMC5867063 DOI: 10.1111/1475-6773.12677] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To examine trends in hospital post-acute utilization indicators and to determine whether improvement in these indicators is associated with attesting to meaningful use (MU). DATA SOURCES Medicare claims-based, repeated measures on 30-day hospital-wide all-cause readmission and emergency department (ED) utilization rates for 160 short-stay hospitals (2009-2012); Medicare EHR Incentive Program Payments files (2011-2012); and other hospital and market data. STUDY DESIGN Interrupted time series with concurrent comparison group. PRINCIPAL FINDINGS Propensity score-weighted multilevel models for change demonstrate that 30-day readmission rates (unadjusted) fell from 13.4 percent in 2009 to 12.1 percent in 2012. Similarly, 30-day ED utilization declined from 18.9 percent to 17.3 percent during the same period. However, MU and non-MU hospitals were indistinguishable vis-à-vis performance. Controlling for hospital and market characteristics, MU was unrelated to 30-day readmission. In contrast, 30-day ED utilization deteriorated. CONCLUSIONS Hospitals with MU Stage 1 designation did not show significantly higher improvement on post-acute utilization compared to their counterparts without. To achieve gains in quality and safety, potentially associated with EHRs, and to advance care coordination and patient engagement, the regulators should strengthen accountability by linking comprehensive, outcomes-based performance measures to specific MU objectives.
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Affiliation(s)
- Yanick N. Brice
- Department of Health Services, Policy, and Practice; CER/PCOR ScholarCenter for Evidence Synthesis in Health; Brown University School of Public HealthProvidenceRI
| | - Karen E. Joynt
- Harvard T. H. Chan School of Public HealthHarvard Medical School; Harvard UniversityBostonMA
| | | | - Grant A. Ritter
- The Heller School for Social Policy and ManagementBrandeis UniversityWalthamMA
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Selvaraj S, Fonarow GC, Sheng S, Matsouaka RA, DeVore AD, Heidenreich PA, Hernandez AF, Yancy CW, Bhatt DL. Association of Electronic Health Record Use With Quality of Care and Outcomes in Heart Failure: An Analysis of Get With The Guidelines-Heart Failure. J Am Heart Assoc 2018; 7:e008158. [PMID: 29602768 PMCID: PMC5907596 DOI: 10.1161/jaha.117.008158] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/06/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adoption of electronic health record (EHR) systems has increased significantly across the nation. Whether EHR use has translated into improved quality of care and outcomes in heart failure (HF) is not well studied. METHODS AND RESULTS We examined participants from the Get With The Guidelines-HF registry who were admitted with HF in 2008 (N=21 222), using various degrees of EHR implementation (no EHR, partial EHR, and full EHR). We performed multivariable logistic regression to determine the relation between EHR status and several in-hospital quality metrics and outcomes. In a substudy of Medicare participants (N=8421), we assessed the relation between EHR status and rates of 30-day mortality, readmission, and a composite outcome. In the cohort, the mean age was 71±15 years, 49% were women, and 64% were white. The mean ejection fraction was 39±17%. Participants were admitted to hospitals with no EHR (N=1484), partial EHR (N=13 473), and full EHR (N=6265). There was no association between EHR status and several quality metrics (aside from β blocker at discharge) or in-hospital outcomes on multivariable adjusted logistic regression (P>0.05 for all comparisons). In the Medicare cohort, there was no association between EHR status and 30-day mortality, readmission, or the combined outcome. CONCLUSIONS In a large registry of hospitalized patients with HF, there was no association between degrees of EHR implementation and several quality metrics and 30-day postdischarge death or readmission. Our results suggest that EHR may not be sufficient to improve HF quality or related outcomes.
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Affiliation(s)
- Senthil Selvaraj
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Gregg C Fonarow
- Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Shubin Sheng
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Roland A Matsouaka
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Adam D DeVore
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Paul A Heidenreich
- Veterans Affairs Health System, Palo Alto, CA
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA
| | - Adrian F Hernandez
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Clyde W Yancy
- Division of Cardiology, Northwestern University, Chicago, IL
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA
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Bang OY, Chang WH, Won HH. Dreaming of the future of stroke: translation of bench to bed. PRECISION AND FUTURE MEDICINE 2017. [DOI: 10.23838/pfm.2017.00163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Soeteman DI, Menzies NA, Pandya A. Would a Large tPA Trial for Those 4.5 to 6.0 Hours from Stroke Onset Be Good Value for Information? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:894-901. [PMID: 28712618 DOI: 10.1016/j.jval.2017.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/21/2017] [Accepted: 03/03/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To quantify the potential value of new research in patients treated with thrombolytic treatment (tissue-type plasminogen activator [tPA]) in the 4.5- to 6.0-hour time window after stroke onset and to determine the optimal size of a future trial using value of information analysis. METHODS Expected value of partial perfect and sample information (EVPPI and EVSI) analyses were conducted using a probabilistic Markov model. Data for modified Rankin Scale (mRS) distributions in patients 4.5 to 6.0 hours since stroke onset for tPA (n = 576) and placebo (n = 543) were obtained from pooled randomized controlled trials. EVSI was quantified with net monetary benefit (assuming willingness to pay for health as $100,000/QALY). We calculated discounted population-level EVSI by multiplying per-person EVSI by the annual number of eligible patients with stroke in the United States and assuming a 10-year time frame of treatment use. Study costs were based on administrative costs and the costs of tPA. RESULTS The base-case lifetime cost-effectiveness analysis showed that tPA was dominated by placebo in this patient group. EVPPI for mRS distributions was $1003 per person. On the basis of EVSI, the optimal sample size of a new trial collecting data on tPA efficacy in these patients would be 5600 across study arms with expected population-level societal returns (EVSI minus study costs) of $68.7 million. CONCLUSIONS Expanding research attention to the 4.5- to 6.0-hour time window for tPA treatment of patients with acute ischemic stroke is justified because the expected returns are substantial. Even a relatively large trial in which more information on treatment efficacy on the basis of mRS scores is collected would represent good value for information.
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Affiliation(s)
- Djøra I Soeteman
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Nicolas A Menzies
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ankur Pandya
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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14
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Keswani A, Uhler LM, Bozic KJ. What Quality Metrics Is My Hospital Being Evaluated on and What Are the Consequences? J Arthroplasty 2016; 31:1139-1143. [PMID: 27101770 DOI: 10.1016/j.arth.2016.01.075] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 01/26/2016] [Indexed: 02/01/2023] Open
Abstract
Quality, experience, and cost are important indicators of value to patients. However, stakeholders have yet to reach agreement on how to define quality and which measures should be used to assess quality. Measures that have been used to assess quality in health care include structural, process, patient experience, efficiency, and outcomes measures. Payers and other quality rating organizations use a combination of measures to rate or rank hospitals on the quality of care they provide. These ratings can be strictly informational or can be used to steer patients, for contracting between payers and providers, and more recently, for adjustments to reimbursements. Physicians and hospitals have a crucial role to play in the development of quality measures that are used to measure and improve value. Consensus on quality measures will facilitate meaningful comparisons across providers and insights that will enable improvements in the value of care we deliver to our patients.
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Affiliation(s)
- Aakash Keswani
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - Lauren M Uhler
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - Kevin J Bozic
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
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15
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Enriquez JR, de Lemos JA, Parikh SV, Simon DN, Thomas LE, Wang TY, Chan PS, Spertus JA, Das SR. Modest Associations Between Electronic Health Record Use and Acute Myocardial Infarction Quality of Care and Outcomes: Results From the National Cardiovascular Data Registry. Circ Cardiovasc Qual Outcomes 2015; 8:576-85. [PMID: 26487739 DOI: 10.1161/circoutcomes.115.001837] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 09/09/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND In 2009, national legislation promoted wide-spread adoption of electronic health records (EHRs) across US hospitals; however, the association of EHR use with quality of care and outcomes after acute myocardial infarction (AMI) remains unclear. METHODS AND RESULTS Data on EHR use were collected from the American Hospital Association Annual Surveys (2007-2010) and data on AMI care and outcomes from the National Cardiovascular Data Registry Acute Coronary Treatment and Interventions Outcomes Network Registry-Get With The Guidelines. Comparisons were made between patients treated at hospitals with fully implemented EHR (n=43 527), partially implemented EHR (n=72 029), and no EHR (n=9270). Overall EHR use increased from 82.1% (183/223) hospitals in 2007 to 99.3% (275/277) hospitals in 2010. Patients treated at hospitals with fully implemented EHRs had fewer heparin overdosing errors (45.7% versus 72.8%; P<0.01) and a higher likelihood of guideline-recommended care (adjusted odds ratio, 1.40 [confidence interval, 1.07-1.84]) compared with patients treated at hospitals with no EHR. In non-ST-segment-elevation AMI, fully implemented EHR use was associated with lower risk of major bleeding (adjusted odds ratio, 0.78 [confidence interval, 0.67-0.91]) and mortality (adjusted odds ratio, 0.82 [confidence interval, 0.69-0.97]) compared with no EHR. In ST-segment-elevation MI, outcomes did not significantly differ by EHR status. CONCLUSIONS EHR use has risen to high levels among hospitals in the National Cardiovascular Data Registry. EHR use was associated with less frequent heparin overdosing and modestly greater adherence to acute MI guideline-recommended therapies. In non-ST-segment-elevation MI, slightly lower adjusted risk of major bleeding and mortality were seen in hospitals implemented with full EHRs; however, in ST-segment-elevation MI, differences in outcomes were not seen.
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Affiliation(s)
- Jonathan R Enriquez
- From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.).
| | - James A de Lemos
- From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.)
| | - Shailja V Parikh
- From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.)
| | - DaJuanicia N Simon
- From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.)
| | - Laine E Thomas
- From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.)
| | - Tracy Y Wang
- From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.)
| | - Paul S Chan
- From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.)
| | - John A Spertus
- From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.)
| | - Sandeep R Das
- From the Department of Medicine, Division of Cardiology, University of Missouri, Kansas City (J.R.E., S.V.P., P.S.C., J.A.S.); Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (J.A.d.L., S.R.D.); Duke Clinical Research Institute, Durham, NC (T.Y.W.); Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine (D.N.S., L.E.T.), Durham, NC; and Department of Medicine, Division of Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C., J.A.S.)
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16
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Windle JR, Windle TA. Electronic Health Records and the Quest to Achieve the "Triple Aim". J Am Coll Cardiol 2015; 65:1973-5. [PMID: 25953749 DOI: 10.1016/j.jacc.2015.03.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/09/2015] [Indexed: 10/23/2022]
Affiliation(s)
- John R Windle
- University of Nebraska Medical Center, Omaha, Nebraska.
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