Centre for IT-enabled Transformation, School of Computing and Information Technology, University of Wollongong, Wollongong, NSW, 2522, Australia.
Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia.
BMC Med Inform Decis Mak. 2020 Mar 20;20(1):58. doi: 10.1186/s12911-020-1070-y.
The Australian government has implemented a compulsory aged care accreditation system to guide and monitor the risk management approach in registered residential aged care (RAC) homes. This research assessed the contribution of electronic health records (EHR) to risk management in RAC homes in relation to the extent that aged care accreditation fulfils its role.
A convenience sample of 5560 aged care accreditation reports published from 2011 to 2018 was manually downloaded from the Accreditation Agency web site. A mixed-method approach of text data mining and manual content analysis was used to identify any significant differences in failure to meet accreditation outcomes among the RAC homes. This took account of whether EHR or paper records were used, year of accreditation, and size and location of the homes.
It appears that aged care accreditation was focused on structure and process, with limited attention to outcome. There was a big variation between homes in their use of measurement indicators to assess accreditation outcomes. No difference was found in outcomes between RAC homes using EHR and those using paper records. Only 3% of the RAC homes were found to have failed some accreditation outcomes. Failure in monitoring mechanism was the key factor for failing many accreditation outcomes. The top five failed outcomes were Human Resource Management, Clinical Care, Information Systems, Medication Management and Behavioural Management.
Sub-optimal outcomes have limited the effectiveness of accreditation in driving and monitoring risk management for care recipient safety in RAC homes. Although EHR is an important structure and process component for RAC services, it made a limited contribution to risk management for accreditation in Australian RAC homes. Either EHR was not effective, or the accreditation process was not robust enough to recognize its influence. Aged care accreditation in Australia needs to develop further outcome-based measures that are supported by robust data infrastructure and clear guidance.
澳大利亚政府实施了强制性的老年护理认证制度，以指导和监测注册的住宿老年护理（RAC）机构的风险管理方法。本研究评估了电子健康记录（EHR）对 RAC 机构风险管理的贡献，以及老年护理认证在多大程度上履行了其职责。
从 2011 年至 2018 年，从认证机构网站上手动下载了 5560 份老年护理认证报告的便利样本。采用文本数据挖掘和手动内容分析的混合方法，以识别在未能达到 RAC 机构认证结果方面的任何显著差异。这考虑了使用 EHR 或纸质记录、认证年份以及机构的规模和位置。
似乎老年护理认证侧重于结构和过程，而对结果的关注有限。在使用评估认证结果的测量指标方面，各机构之间存在很大差异。使用 EHR 和纸质记录的 RAC 机构之间在结果方面没有差异。仅发现 3%的 RAC 机构未能达到一些认证结果。监测机制的失败是许多认证结果失败的关键因素。排名前五的失败结果是人力资源管理、临床护理、信息系统、药物管理和行为管理。
不理想的结果限制了认证在推动和监测 RAC 机构中护理接受者安全的风险管理方面的有效性。尽管 EHR 是 RAC 服务的重要结构和过程组成部分，但它对澳大利亚 RAC 机构的认证风险管理贡献有限。要么 EHR 没有效果，要么认证过程不够强大，无法识别其影响。澳大利亚的老年护理认证需要制定进一步的基于结果的措施，这些措施需要得到强大的数据基础设施和明确指导的支持。
