Furukawa Michael F, Spector William D, Rhona Limcangco M, Encinosa William E
Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, MD, USA.
Social and Scientific Systems, Silver Spring, MD, USA.
J Am Med Inform Assoc. 2017 Jul 1;24(4):729-736. doi: 10.1093/jamia/ocw183.
Nationwide initiatives have promoted greater adoption of health information technology as a means to reduce adverse drug events (ADEs). Hospital adoption of electronic health records with Meaningful Use (MU) capabilities expected to improve medication safety has grown rapidly. However, evidence that MU capabilities are associated with declines in in-hospital ADEs is lacking.
Data came from the 2010-2013 Medicare Patient Safety Monitoring System and the 2008-2013 Healthcare Information and Management Systems Society (HIMSS) Analytics Database. Two-level random intercept logistic regression was used to estimate the association of MU capabilities and occurrence of ADEs, adjusting for patient characteristics, hospital characteristics, and year of observation.
Rates of in-hospital ADEs declined by 19% from 2010 to 2013. Adoption of MU capabilities was associated with 11% lower odds of an ADE (95% confidence interval [CI], 0.84-0.96). Interoperability capability was associated with 19% lower odds of an ADE (95% CI, 0.67- 0.98). Adoption of MU capabilities explained 22% of the observed reduction in ADEs, or 67,000 fewer ADEs averted by MU.
Concurrent with the rapid uptake of MU and interoperability, occurrence of in-hospital ADEs declined significantly from 2010 to 2013. MU capabilities and interoperability were associated with lower occurrence of ADEs, but the effects did not vary by experience with MU. About one-fifth of the decline in ADEs from 2010 to 2013 was attributable to MU capabilities.
Findings support the contention that adoption of MU capabilities and interoperability spurred by the Health Information Technology for Economic and Clinical Health Act contributed in part to the recent decline in ADEs.
全国性倡议推动了健康信息技术的更多采用，以此作为减少药物不良事件（ADEs）的一种手段。医院采用具有有意义使用（MU）功能的电子健康记录有望改善用药安全，其采用率迅速增长。然而，缺乏证据表明MU功能与住院期间ADEs的减少有关。
数据来自2010 - 2013年医疗保险患者安全监测系统以及2008 - 2013年医疗保健信息与管理系统学会（HIMSS）分析数据库。采用两级随机截距逻辑回归来估计MU功能与ADEs发生之间的关联，并对患者特征、医院特征和观察年份进行了调整。
2010年至2013年期间，住院ADEs发生率下降了19%。采用MU功能与ADEs发生几率降低11%相关（95%置信区间[CI]，0.84 - 0.96）。互操作性功能与ADEs发生几率降低19%相关（95% CI，0.67 - 0.98）。采用MU功能解释了观察到ADEs减少的22%，即MU避免了67000例ADEs。
在MU和互操作性迅速普及的同时，2010年至2013年期间住院ADEs的发生率显著下降。MU功能和互操作性与ADEs发生率较低相关，但效果并未因MU使用经验而有所不同。2010年至2013年ADEs下降的约五分之一可归因于MU功能。
研究结果支持这样的观点，即《经济和临床健康的健康信息技术法案》推动的MU功能和互操作性的采用，部分促成了近期ADEs的下降。
