Department of Medicine, Cambridge Hospital/Harvard Medical School, Cambridge, MA 02139, USA.
Am J Med. 2010 Jan;123(1):40-6. doi: 10.1016/j.amjmed.2009.09.004. Epub 2009 Nov 24.
Many believe that computerization will improve health care quality, reduce costs, and increase administrative efficiency. However, no previous studies have examined computerization's cost and quality impacts at a diverse national sample of hospitals.
We linked data from an annual survey of computerization at approximately 4000 hospitals for the period from 2003 to 2007 with administrative cost data from Medicare Cost Reports and cost and quality data from the 2008 Dartmouth Health Atlas. We calculated an overall computerization score and 3 subscores based on 24 individual computer applications, including the use of computerized practitioner order entry and electronic medical records. We analyzed whether more computerized hospitals had lower costs of care or administration, or better quality. We also compared hospitals included on a list of the "100 Most Wired" with others.
More computerized hospitals had higher total costs in bivariate analyses (r=0.06, P=.001) but not multivariate analyses (P=.69). Neither overall computerization scores nor subscores were consistently related to administrative costs, but hospitals that increased computerization faster had more rapid administrative cost increases (P=.0001). Higher overall computerization scores correlated weakly with better quality scores for acute myocardial infarction (r=0.07, P=.003), but not for heart failure, pneumonia, or the 3 conditions combined. In multivariate analyses, more computerized hospitals had slightly better quality. Hospitals on the "Most Wired" list performed no better than others on quality, costs, or administrative costs.
As currently implemented, hospital computing might modestly improve process measures of quality but does not reduce administrative or overall costs.
许多人认为计算机化将提高医疗质量、降低成本并提高行政效率。然而，以前没有研究在多样化的全国医院样本中检查计算机化的成本和质量影响。
我们将 2003 年至 2007 年期间对大约 4000 家医院进行计算机化的年度调查数据与医疗保险成本报告中的行政成本数据以及 2008 年达特茅斯健康地图集的成本和质量数据相链接。我们根据 24 项个别计算机应用程序（包括使用计算机化医师医嘱输入和电子病历）计算了一个总体计算机化评分和 3 个子评分。我们分析了更多计算机化的医院是否具有更低的护理或行政管理成本，或者具有更好的质量。我们还比较了列入“100 家最先进医院”名单的医院与其他医院。
在单变量分析中，更多计算机化的医院具有更高的总费用（r=0.06，P=.001），但在多变量分析中则不然（P=.69）。总体计算机化评分和子评分均与行政成本无一致关系，但计算机化速度更快的医院行政成本增长更快（P=.0001）。更高的总体计算机化评分与急性心肌梗死（r=0.07，P=.003）的质量评分略有相关，但与心力衰竭、肺炎或这三种情况的综合评分则无关。在多变量分析中，更多计算机化的医院具有略好的质量。列入“最先进医院”名单的医院在质量、成本或行政成本方面的表现并不优于其他医院。
按照目前的实施情况，医院计算机化可能会适度提高质量的过程指标，但不会降低行政或总体成本。
