Menachemi Nir, Chukmaitov Askar, Saunders Charles, Brooks Robert G
Center on Patient Safety, Florida State University College of Medicine, Tallahassee, FL, USA.
Health Care Manage Rev. 2008 Jan-Mar;33(1):51-9. doi: 10.1097/01.HMR.0000304497.89684.36.
Hospitals have been slow to adopt information technology (IT) largely because of a lack of generalizable evidence of the value associated with such adoption.
To explore the relationship between IT adoption and quality of care in acute-care hospitals.
Primary data on hospital IT adoption were combined with secondary hospital discharge data. Regression analyses were used to examine the relationship between various measures of IT adoption and several quality indicators after controlling for confounders. Adoption of IT was measured using a previously validated method that considers clinical, administrative, and strategic IT capabilities of acute-care hospitals. Quality measures included the Inpatient Quality Indicators developed by the Agency for Healthcare Research and Quality.
Data from 98 hospitals were available for analyses. Hospitals adopted an average of 11.3 (45.2%) clinical IT applications, 15.7 (74.8%) administrative IT applications, and 5 (50%) strategic IT applications. In multivariate regression analyses, hospitals that adopted a greater number of IT applications were significantly more likely to have desirable quality outcomes on seven Inpatient Quality Indicator measures, including risk-adjusted mortality from percutaneous transluminal coronary angioplasty, gastrointestinal hemorrhage, and acute myocardial infarction. An increase in clinical IT applications was also inversely correlated with utilization of incidental appendectomy, and an increase in the adoption of strategic IT applications was inversely correlated with risk-adjusted mortality from craniotomy and laparoscopic cholecystectomy.
Hospital adoption of IT is associated with desirable quality outcomes across hospitals in Florida. These findings will assist hospital leaders interested in understanding better the effect of costly IT adoption on quality of care in their institutions.
医院在采用信息技术（IT）方面进展缓慢，主要原因是缺乏与这种采用相关价值的可推广证据。
探讨急症医院采用IT与医疗质量之间的关系。
将医院IT采用的原始数据与医院出院二级数据相结合。在控制混杂因素后，使用回归分析来检验IT采用的各种衡量指标与几个质量指标之间的关系。IT采用情况通过一种先前验证的方法进行衡量，该方法考虑了急症医院的临床、行政和战略IT能力。质量指标包括医疗保健研究与质量局制定的住院患者质量指标。
有98家医院的数据可用于分析。医院平均采用了11.3种（45.2%）临床IT应用程序、15.7种（74.8%）行政IT应用程序和5种（50%）战略IT应用程序。在多变量回归分析中，采用更多IT应用程序的医院在七种住院患者质量指标衡量方面显著更有可能获得理想的质量结果，包括经皮冠状动脉腔内血管成形术、胃肠道出血和急性心肌梗死的风险调整死亡率。临床IT应用程序的增加也与阑尾切除术的使用率呈负相关，战略IT应用程序采用率的增加与开颅手术和腹腔镜胆囊切除术的风险调整死亡率呈负相关。
佛罗里达州各医院采用IT与理想的质量结果相关。这些发现将有助于有兴趣更好地了解采用成本高昂的IT对其机构医疗质量影响的医院领导者。
