Center for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
Centre for Online Health, The University of Queensland, Brisbane, Australia; Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
Int J Med Inform. 2021 Jul;151:104471. doi: 10.1016/j.ijmedinf.2021.104471. Epub 2021 Apr 24.
The implementation of electronic health records (EHRs) in the aged care sector has been shown to improve efficiency and quality of care, administrative and funding processes. The aim of this study was to examine whether implementing EHRs and/or interventions leveraging EHRs in residential aged care facilities has any impact on health outcomes for residents and to review and summarise any published evidence.
Using the Joanna Briggs Institute guidelines for conducting scoping reviews, we searched PubMed, CINAHL, Embase, Cochrane and Scopus databases for articles describing the impact of EHRs and/or EHR-based interventions on health outcomes for residents in residential aged care. We included journal articles published in English between 2009 and 2019. After identifying articles meeting the inclusion criteria, we extracted individual findings and produced a narrative summary.
Out of 6576 articles identified through database searches, seven met our inclusion criteria. The articles varied in study design, experimental methods, sample sizes and health outcomes assessed but there were no randomised controlled trials: four articles employed quantitative methods and three employed both quantitative and qualitative methods. The implementation of EHR-based interventions had positive impact on outcomes related to excessive weight loss, malnutrition, mobility, weighing of residents and use of antipsychotic medicines but had mixed impact (i.e., positive impact in some studies but non-significant or negative impact in others) on pressure ulcers, activities of daily living, behavioural symptoms, use of physical restraints and signs of depression. We also found that these interventions had no statistically significant impact on medication discrepancies, adverse drug events, falls or mortality.
In conclusion, research in this area is not yet comprehensive enough to reach a definitive conclusion on the impact of EHR-based interventions on health outcomes in residential aged care. As provider organisations increasingly implement EHRs, more research is needed to study their impact on resident health outcomes and examine how this impact eventuates.
在老年护理行业实施电子健康记录（EHR）已被证明可以提高效率和护理质量，以及行政和资金流程。本研究旨在考察在养老院实施 EHR 和/或利用 EHR 的干预措施是否对居民的健康结果有任何影响，并审查和总结任何已发表的证据。
我们使用 Joanna Briggs 研究所的指南进行范围综述，在 PubMed、CINAHL、Embase、Cochrane 和 Scopus 数据库中搜索描述 EHR 和/或基于 EHR 的干预措施对养老院居民健康结果影响的文章。我们纳入了 2009 年至 2019 年期间以英文发表的期刊文章。在确定符合纳入标准的文章后，我们提取了个别发现并制作了叙述性总结。
通过数据库搜索共确定了 6576 篇文章，其中 7 篇符合纳入标准。这些文章在研究设计、实验方法、样本量和评估的健康结果方面存在差异，但没有随机对照试验：4 篇文章采用了定量方法，3 篇文章同时采用了定量和定性方法。基于 EHR 的干预措施的实施对与过度体重减轻、营养不良、活动能力、居民称重和使用抗精神病药物相关的结果有积极影响，但对压疮、日常生活活动、行为症状、使用身体约束和抑郁迹象的影响存在差异（即，在一些研究中具有积极影响，但在其他研究中则不显著或具有负面影响）。我们还发现，这些干预措施对药物差异、药物不良反应、跌倒或死亡率没有统计学上的显著影响。
总之，该领域的研究还不够全面，无法就基于 EHR 的干预措施对养老院居民健康结果的影响得出明确结论。随着医疗机构越来越多地实施 EHR，需要进行更多的研究来研究它们对居民健康结果的影响，并研究这种影响的发生方式。
