Tuck School of Business, Dartmouth College, Hanover, New Hampshire 03755, USA.
J Am Med Inform Assoc. 2012 May-Jun;19(3):360-7. doi: 10.1136/amiajnl-2011-000289. Epub 2011 Oct 28.
To determine whether the use of computerized physician order entry (CPOE) and electronic medication administration records (eMAR) is associated with better quality of medication administration at medium-to-large acute-care hospitals. DATA/STUDY SETTING: A retrospective cross-sectional analysis of data from three sources: CPOE/eMAR usage from HIMSS Analytics (2010), medication quality scores from CMS Hospital Compare (2010), and hospital characteristics from CMS Acute Inpatient Prospective Payment System (2009). The analysis focused on 11 quality indicators (January-December 2009) at 2603 medium-to-large (≥ 100 beds), non-federal acute-care hospitals measuring proportion of eligible patients given (or prescribed) recommended medications for conditions, including acute myocardial infarction, heart failure, and pneumonia, and surgical care improvement. Using technology adoption by 2008 as reference, hospitals were coded: (1) eMAR-only adopters (n=986); (2) CPOE-only adopters (n=115); and (3) adopters of both technologies (n=804); with non-adopters of both technologies as reference group (n=698). Hospitals were also coded for duration of use in 2-year increments since technology adoption. Hospital characteristics, historical measure-specific patient volume, and propensity scores for technology adoption were used to control for confounding factors. The analysis was performed using a generalized linear model (logit link and binomial family).
Relative to non-adopters of both eMAR and CPOE, the odds of adherence to all measures (except one) were higher by 14-29% for eMAR-only hospitals and by 13-38% for hospitals with both technologies, translating to a marginal increase of 0.4-2.0 percentage points. Further, each additional 2 years of technology use was associated with 6-15% higher odds of compliance on all medication measures for eMAR-only hospitals and users of both technologies.
Implementation and duration of use of health information technologies are associated with improved adherence to medication guidelines at US hospitals. The benefits are evident for adoption of eMAR systems alone and in combination with CPOE.
确定在中大型急性护理医院中，使用计算机化医嘱输入 (CPOE) 和电子用药记录 (eMAR) 是否与更好的用药管理质量相关。
数据/研究设置：对来自三个来源的数据进行回顾性横断面分析：HIMSS Analytics 的 CPOE/eMAR 使用情况（2010 年）、CMS 医院比较的用药质量评分（2010 年）和 CMS 急性住院患者前瞻性支付系统的医院特征（2009 年）。该分析集中于 2009 年 1 月至 12 月的 11 个质量指标，涉及 2603 家中大型（≥ 100 张病床）、非联邦急性护理医院，用于衡量符合条件的患者接受（或开处方）推荐药物治疗包括急性心肌梗死、心力衰竭和肺炎以及手术护理改善的比例。以 2008 年的技术采用情况为参考，对医院进行编码：（1）仅采用 eMAR 的采用者（n=986）；（2）仅采用 CPOE 的采用者（n=115）；（3）同时采用两种技术的采用者（n=804）；以同时不采用两种技术的医院作为参考组（n=698）。还根据自技术采用以来每两年的使用时间对医院进行编码。医院特征、历史特定患者数量以及技术采用的倾向得分用于控制混杂因素。分析使用广义线性模型（对数链接和二项式家族）进行。
与同时不采用 eMAR 和 CPOE 的医院相比，仅采用 eMAR 的医院对所有措施（除一项措施外）的依从率提高了 14-29%，同时采用两种技术的医院提高了 13-38%，这意味着依从率平均增加了 0.4-2.0 个百分点。此外，仅采用 eMAR 的医院和同时采用两种技术的医院，每增加两年的技术使用，所有用药措施的依从率提高了 6-15%。
在美国医院，卫生信息技术的实施和使用时间与提高用药指南的依从性相关。单独采用 eMAR 系统以及同时采用 CPOE 和 eMAR 系统都具有明显的益处。
