电子病历、护士人力配置与护士敏感型患者结局：来自 1998-2007 年加利福尼亚州医院的证据。
Electronic medical records, nurse staffing, and nurse-sensitive patient outcomes: evidence from California hospitals, 1998-2007.
机构信息
School of Health Management and Policy, W. P. Carey School of Business, Arizona State University, PO Box 874506, Tempe, AZ 85287-4506, USA.
出版信息
Health Serv Res. 2010 Aug;45(4):941-62. doi: 10.1111/j.1475-6773.2010.01110.x. Epub 2010 Apr 9.
OBJECTIVE
To estimate the effects of electronic medical records (EMR) implementation on medical-surgical acute unit costs, length of stay, nurse staffing levels, nursing skill mix, nurse cost per hour, and nurse-sensitive patient outcomes.
DATA SOURCES
Data on EMR implementation came from the 1998-2007 HIMSS Analytics Databases. Data on nurse staffing and patient outcomes came from the 1998-2007 Annual Financial Disclosure Reports and Patient Discharge Databases of the California Office of Statewide Health Planning and Development (OSHPD).
METHODS
Longitudinal analysis of an unbalanced panel of 326 short-term, general acute care hospitals in California. Marginal effects estimated using fixed effects (within-hospital) OLS regression.
PRINCIPAL FINDINGS
EMR implementation was associated with 6-10 percent higher cost per discharge in medical-surgical acute units. EMR stage 2 increased registered nurse hours per patient day by 15-26 percent and reduced licensed vocational nurse cost per hour by 2-4 percent. EMR stage 3 was associated with 3-4 percent lower rates of in-hospital mortality for conditions.
CONCLUSIONS
Our results suggest that advanced EMR applications may increase hospital costs and nurse staffing levels, as well as increase complications and decrease mortality for some conditions. Contrary to expectation, we found no support for the proposition that EMR reduced length of stay or decreased the demand for nurses.
目的
评估电子病历（EMR）实施对内科-外科急性病房单位成本、住院时间、护士人员配备水平、护理技能组合、护士每小时成本以及护士敏感患者结局的影响。
资料来源
EMR 实施数据来自 1998-2007 年 HIMSS 分析数据库。护士人员配备和患者结局数据来自 1998-2007 年加州州立卫生规划与发展办公室（OSHPD）年度财务披露报告和患者出院数据库。
方法
对加利福尼亚州 326 家短期、普通急性护理医院的不平衡面板进行纵向分析。使用固定效应（院内）OLS 回归估计边际效应。
主要发现
EMR 实施与内科-外科急性病房每出院人次成本增加 6-10%相关。EMR 第 2 阶段使每位患者每天的注册护士小时数增加了 15-26%，并使持照职业护士每小时成本降低了 2-4%。EMR 第 3 阶段与某些情况下院内死亡率降低 3-4%相关。
结论
我们的结果表明，先进的 EMR 应用程序可能会增加医院成本和护士人员配备水平，并增加某些情况下的并发症，降低死亡率。与预期相反，我们没有发现 EMR 缩短住院时间或减少对护士需求的证据。
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