Bjarnadottir Ragnhildur I, Herzig Carolyn T A, Travers Jasmine L, Castle Nicholas G, Stone Patricia W
Author Affiliations: Center for Health Policy, Columbia University School of Nursing (Drs Bjarnadottir, Herzig, Stone, and Travers); and Department of Epidemiology, Columbia University Mailman School of Public Health (Dr Herzig), New York, NY; and Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, PA (Dr Castle).
Comput Inform Nurs. 2017 Aug;35(8):417-424. doi: 10.1097/CIN.0000000000000344.
While electronic health records have emerged as promising tools to help improve quality of care, nursing homes have lagged behind in implementation. This study assessed electronic health records implementation, associated facility characteristics, and potential impact on quality indicators in nursing homes. Using national Centers for Medicare & Medicaid Services and survey data for nursing homes, a cross-sectional analysis was conducted to identify variations between nursing homes that had and had not implemented electronic health records. A difference-in-differences analysis was used to estimate the longitudinal effect of electronic health records on commonly used quality indicators. Data from 927 nursing homes were examined, 49.1% of which had implemented electronic health records. Nursing homes with electronic health records were more likely to be nonprofit/government owned (P = .04) and had a lower percentage of Medicaid residents (P = .02) and higher certified nursing assistant and registered nurse staffing levels (P = .002 and .02, respectively). Difference-in-differences analysis showed greater quality improvements after implementation for five long-stay and two short-stay quality measures (P = .001 and .01, respectively) compared with those who did not implement electronic health records. Implementation rates in nursing homes are low compared with other settings, and better-resourced facilities are more likely to have implemented electronic health records. Consistent with other settings, electronic health records implementation improves quality in nursing homes, but further research is needed to better understand the mechanism for improvement and how it can best be supported.
虽然电子健康记录已成为有助于提高医疗质量的有前景的工具，但养老院在实施方面却落后了。本研究评估了养老院电子健康记录的实施情况、相关的机构特征以及对质量指标的潜在影响。利用美国医疗保险和医疗补助服务中心的全国数据以及养老院的调查数据，进行了横断面分析，以确定已实施和未实施电子健康记录的养老院之间的差异。采用差异分析来估计电子健康记录对常用质量指标的纵向影响。研究考察了927家养老院的数据，其中49.1%已实施电子健康记录。拥有电子健康记录的养老院更有可能是非营利性/政府所有（P = .04），医疗补助居民的比例较低（P = .02），注册护理助理和注册护士的人员配备水平较高（分别为P = .002和.02）。差异分析显示，与未实施电子健康记录的养老院相比，在实施后，五项长期居住和两项短期居住质量指标有更大的质量改善（分别为P = .001和.01）。与其他机构相比，养老院的实施率较低，资源更充足的机构更有可能实施电子健康记录。与其他机构一致，电子健康记录的实施提高了养老院的质量，但需要进一步研究以更好地理解改善机制以及如何最好地支持这种改善。
