与癌症医院采用电子健康记录相关的环境市场因素。
Environmental market factors associated with electronic health record adoption among cancer hospitals.
机构信息
Will L. Tarver, DrPH, MLIS, is Postdoctoral Fellow, Training in Research for Behavioral Oncology and Cancer Control Program, Indiana University, and Postdoctoral Fellow, Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana. E-mail:
出版信息
Health Care Manage Rev. 2018 Oct/Dec;43(4):303-314. doi: 10.1097/HMR.0000000000000149.
BACKGROUND
Although recent literature has explored the relationship between various environmental market characteristics and the adoption of electronic health records (EHRs) among general, acute care hospitals, no such research currently exists for specialty hospitals, including those providing cancer care.
PURPOSE
The aim of the study was to examine the relationship between market characteristics and the adoption of EHRs among Commission on Cancer (CoC)-accredited hospitals.
METHODS/APPROACH: Secondary data on EHR adoption combined with hospital and environmental market characteristics were analyzed using logistic regression. Using the resource dependence theory, we examined how measures of munificence, complexity, and dynamism are related to the adoption of EHRs among CoC-accredited hospitals and, separately, hospitals not CoC-accredited.
FINDINGS
In a sample of 2,670 hospitals, 141 (0.05%) were academic-based CoC-accredited hospitals and 562 (21%) were community-based CoC-accredited hospitals. Measures of munificence such as cancer incidence rates (OR = 0.99, CI [0.99, 1.00], p = .020) and percentage population aged 65+ (OR = 0.99, CI [0.99, 1.00], p = .001) were negatively associated with basic EHR adoption, whereas urban location was positively associated with comprehensive EHR adoption (OR = 3.07, CI [0.89, 10.61], p = .076) for community-based CoC-accredited hospitals. Measures of complexity such as hospitals in areas with less competition were less likely to adopt a basic EHR (OR = 0.33, CI [0.19, 0.96], p = .005), whereas Medicare Managed Care penetration was positively associated with comprehensive EHR adoption (OR = 1.02, CI [1.00, 1.05], p = .070) among community-based CoC-accredited hospitals. Lastly, dynamism, measured as population change, was negatively associated with the adoption of comprehensive EHRs (OR = 0.99, CI [0.99, 1.00], p = .070) among academic-based CoC-accredited hospitals.
PRACTICE IMPLICATIONS
A greater understanding of the environment's relationship to health information technology adoption in cancer hospitals will help stakeholders in these institutions make informed strategic decisions about information technology investments guided by their facilities' respective environmental factors. The results of this study may also be useful to hospital chief information officers and chief executive officers seeking to either improve their quality of care or achieve and maintain accreditation in providing cancer care.
背景
尽管最近的文献探讨了各种环境市场特征与一般急性护理医院采用电子健康记录（EHR）之间的关系，但对于专门医院（包括提供癌症护理的医院），目前尚无此类研究。
目的
本研究旨在检查市场特征与癌症委员会（CoC）认证医院采用 EHR 之间的关系。
方法/方法：使用逻辑回归分析了 EHR 采用情况与医院和环境市场特征的二次数据。利用资源依赖理论，我们研究了丰富性、复杂性和动态性等措施与 CoC 认证医院和未获得 CoC 认证的医院采用 EHR 的关系。
发现
在 2670 家医院的样本中，有 141 家（0.05%）是学术型 CoC 认证医院，562 家（21%）是社区型 CoC 认证医院。丰富性指标，如癌症发病率（OR=0.99，CI[0.99，1.00]，p=0.020）和 65 岁以上人口百分比（OR=0.99，CI[0.99，1.00]，p=0.001）与基本 EHR 采用呈负相关，而城市位置与社区型 CoC 认证医院的综合 EHR 采用呈正相关（OR=3.07，CI[0.89，10.61]，p=0.076）。复杂性指标，如竞争较少地区的医院，不太可能采用基本 EHR（OR=0.33，CI[0.19，0.96]，p=0.005），而医疗保险管理式医疗渗透率与社区型 CoC 认证医院的综合 EHR 采用呈正相关（OR=1.02，CI[1.00，1.05]，p=0.070）。最后，以人口变化衡量的动态性与学术型 CoC 认证医院综合 EHR 的采用呈负相关（OR=0.99，CI[0.99，1.00]，p=0.070）。
实践意义
更好地了解环境与癌症医院中健康信息技术采用之间的关系，将有助于这些机构的利益相关者根据其设施的环境因素做出明智的信息技术投资决策。本研究的结果也可能对寻求提高护理质量或在提供癌症护理方面实现和维持认证的医院首席信息官和首席执行官有用。
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