Ford Eric W, Silvera Geoffrey A, Kazley Abby S, Diana Mark L, Huerta Timothy R
Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland, US.
Department of Political Science, Auburn University, Auburn, Alabama, US.
Int J Health Care Qual Assur. 2016 Jul 11;29(6):614-27. doi: 10.1108/IJHCQA-10-2015-0125.
Purpose - The purpose of this paper is to explore the relationship between hospitals' electronic health record (EHR) adoption characteristics and their patient safety cultures. The "Meaningful Use" (MU) program is designed to increase hospitals' adoption of EHR, which will lead to better care quality, reduce medical errors, avoid unnecessary cost, and promote a patient safety culture. To reduce medical errors, hospital leaders have been encouraged to promote safety cultures common to high-reliability organizations. Expecting a positive relationship between EHR adoption and improved patient safety cultures appears sound in theory, but it has yet to be empirically demonstrated. Design/methodology/approach - Providers' perceptions of patient safety culture and counts of patient safety incidents are explored in relationship to hospital EHR adoption patterns. Multi-level modeling is employed to data drawn from the Agency for Healthcare Research and Quality's surveys on patient safety culture (level 1) and the American Hospital Association's survey and healthcare information technology supplement (level 2). Findings - The findings suggest that the early adoption of EHR capabilities hold a negative association to the number of patient safety events reported. However, this relationship was not present in providers' perceptions of overall patient safety cultures. These mixed results suggest that the understanding of the EHR-patient safety culture relationship needs further research. Originality/value - Relating EHR MU and providers' care quality attitudes is an important leading indicator for improved patient safety cultures. For healthcare facility managers and providers, the ability to effectively quantify the impact of new technologies on efforts to change organizational cultures is important for pinpointing clinical areas for process improvements.
目的——本文旨在探讨医院电子健康记录（EHR）采用特征与其患者安全文化之间的关系。“有意义使用”（MU）计划旨在提高医院对EHR的采用率，这将带来更好的护理质量、减少医疗差错、避免不必要的成本并促进患者安全文化。为减少医疗差错，医院领导被鼓励推广高可靠性组织共有的安全文化。从理论上看，EHR采用与改善患者安全文化之间存在积极关系似乎是合理的，但尚未得到实证证明。
设计/方法/途径——探讨医疗服务提供者对患者安全文化的认知以及患者安全事件数量与医院EHR采用模式之间的关系。采用多层次建模方法对来自医疗保健研究与质量局关于患者安全文化的调查（第1层）以及美国医院协会的调查和医疗信息技术补充调查（第2层）的数据进行分析。
研究结果——研究结果表明，早期采用EHR功能与报告的患者安全事件数量呈负相关。然而，在医疗服务提供者对整体患者安全文化的认知中，这种关系并不存在。这些混合结果表明，对EHR与患者安全文化关系的理解需要进一步研究。
原创性/价值——将EHR的“有意义使用”与医疗服务提供者的护理质量态度联系起来是改善患者安全文化的一个重要先行指标。对于医疗保健机构管理人员和医疗服务提供者而言，有效量化新技术对改变组织文化努力的影响的能力对于确定流程改进的临床领域很重要。
