Paez Kathryn, Roper Rebecca A, Andrews Roxanne M
American Institutes for Research, Silver Spring, Maryland, USA.
Jt Comm J Qual Patient Saf. 2013 Sep;39(9):415-25. doi: 10.1016/s1553-7250(13)39055-2.
The literature indicates that health information technology (IT) use may lead to some gains in the quality and safety of care in some situations but provides little insight into this variability in the results that has been found. The inconsistent findings point to the need for a conceptual model that will guide research in sorting out the complex relationships between health IT and the quality and safety of care.
A conceptual model was developed that describes how specific health IT functions could affect different types of inpatient safety errors and that include contextual factors that influence successful health IT implementation. The model was applied to a readily available patient safety measure and nationwide data (2009 AHA Annual Survey Information Technology Supplement and 2009 Healthcare Cost and Utilization Project State Inpatient Databases).
The model was difficult to operationalize because (1) available health IT adoption data did not characterize health IT features and extent of usage, and (2) patient safety measures did not elucidate the process failures leading to safety-related outcomes. The sample patient safety measure--Postoperative Physiologic and Metabolic Derangement Rate--was not significantly related to self-reported health IT capabilities when adjusted for hospital structural characteristics.
These findings illustrate the critical need for collecting data that are germane to health IT and the possible mechanisms by which health IT may affect inpatient safety. Well-defined and sufficiently granular measures of provider's correct use of health IT functions, the contextual factors surrounding health IT use, and patient safety errors leading to health care-associated conditions are needed to illuminate the impact of health IT on patient safety.
文献表明，在某些情况下，健康信息技术（IT）的使用可能会在一定程度上提高医疗质量和安全性，但对于已发现的结果差异却鲜有深入见解。研究结果不一致表明，需要一个概念模型来指导研究，以理清健康信息技术与医疗质量和安全性之间的复杂关系。
开发了一个概念模型，该模型描述了特定的健康信息技术功能如何影响不同类型的住院患者安全错误，并纳入了影响健康信息技术成功实施的背景因素。该模型应用于一项现成的患者安全指标和全国性数据（2009年美国心脏协会年度调查信息技术增刊以及2009年医疗保健成本与利用项目州住院数据库）。
该模型难以实施，原因如下：（1）现有的健康信息技术采用数据未对健康信息技术的特征和使用程度进行描述；（2）患者安全指标未阐明导致与安全相关结果的过程故障。在对医院结构特征进行调整后，样本患者安全指标——术后生理和代谢紊乱率——与自我报告的健康信息技术能力无显著相关性。
这些研究结果表明，迫切需要收集与健康信息技术相关的数据，以及健康信息技术可能影响住院患者安全的潜在机制。需要明确界定且足够细化的指标，以衡量医疗服务提供者对健康信息技术功能的正确使用、健康信息技术使用的背景因素，以及导致医疗相关状况的患者安全错误，从而阐明健康信息技术对患者安全的影响。
