Arizona State University, Tempe, AZ, USA.
Med Care Res Rev. 2011 Feb;68(1):75-95. doi: 10.1177/1077558710372108. Epub 2010 Jun 16.
This study examined the relationship between electronic medical records (EMR) sophistication and the efficiency of U.S. hospital emergency departments (EDs). Using data from the 2006 National Hospital Ambulatory Medical Care Survey, survey-weighted ordinary least squares regressions were used to estimate the association of EMR sophistication with ED throughput and probability a patient left without treatment. Instrumental variables were used to test for the presence of endogeneity and reverse causality. Greater EMR sophistication had a mixed association with ED efficiency. Relative to EDs with minimal or no EMR, fully functional EMR was associated with 22.4% lower ED length of stay and 13.1% lower diagnosis/treatment time. However, the relationships varied by patient acuity level and diagnostic services provided. Surprisingly, EDs with basic EMR were not more efficient on average, and basic EMR had a nonlinear relationship with efficiency that varied with the number of EMR functions used.
本研究考察了电子病历 (EMR) 复杂度与美国医院急诊部 (ED) 效率之间的关系。利用 2006 年全国医院门诊医疗调查的数据，采用调查加权最小二乘法回归估计 EMR 复杂度与 ED 吞吐量和患者未接受治疗离开的概率之间的关联。使用工具变量来检验内生性和反向因果关系的存在。更高的 EMR 复杂度与 ED 效率呈混合关联。与仅有最低限度或没有 EMR 的 ED 相比，功能齐全的 EMR 与 ED 住院时间减少 22.4%和诊断/治疗时间减少 13.1%相关。然而，这些关系因患者严重程度水平和提供的诊断服务而异。令人惊讶的是，平均而言，具有基本 EMR 的 ED 效率并不更高，并且基本 EMR 与效率之间存在非线性关系，这种关系随使用的 EMR 功能数量而变化。
