University of California, San Francisco, San Francisco.
Brigham & Women's Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
JAMA Netw Open. 2021 Sep 1;4(9):e2125173. doi: 10.1001/jamanetworkopen.2021.25173.
Despite billions spent in public investment, electronic health records (EHRs) have not delivered on the promise of large quality and safety improvement. Simultaneously, there is debate on whether public quality reporting is a useful tool to incentivize quality improvement.
To evaluate whether publicly reported feedback was associated with hospital improvement in an evaluation of medication-related clinical decision support (CDS) safety performance.
DESIGN, SETTINGS, AND PARTICIPANTS: This nonrandomized controlled trial included US hospitals that participated in the Computerized Provider Order Entry (CPOE) Evaluation Tool in the Leapfrog Hospital Survey, a national quality reporting program that evaluates safety performance of hospital CDS using simulated orders and patients, in 2017 to 2018. A sharp regression discontinuity design was used to identify the association of receiving negative feedback with hospital performance improvement in the subsequent year. Data were analyzed from January through September 2020.
Publicly reported quality feedback.
The main outcome was improvement from 2017 to 2018 on the Leapfrog CPOE Evaluation Tool, using regression discontinuity model estimates of the association of receiving negative publicly reported feedback with quality improvement.
A total of 1183 hospitals were included, with a mean (SD) CPOE score of 59.3% (16.3%) at baseline. Hospitals receiving negative feedback improved 8.44 (95% CI, 0.09 to 16.80) percentage points more in the subsequent year compared with hospitals that received positive feedback on the same evaluation. This change was driven by differences in improvement in basic CDS capabilities (β = 8.71 [95%CI, 1.67 to 18.73]) rather than advanced CDS (β = 6.15 [95% CI, -9.11 to 26.83]).
In this nonrandomized controlled trial, publicly reported feedback was associated with quality improvement, suggesting targeted measurement and reporting of process quality may be an effective policy lever to encourage improvement in specific areas. Clinical decision support represents an important tool in ensuring patient safety and decreasing adverse drug events, especially for complex patients and those with multiple chronic conditions who often receive several different drugs during an episode of care.
尽管公共投资数十亿美元，但电子健康记录 (EHR) 并未实现大幅提高质量和安全性的承诺。与此同时，关于公共质量报告是否是激励质量改进的有用工具也存在争议。
评估公开报告的反馈是否与医院在评估与药物相关的临床决策支持 (CDS) 安全性能方面的改进有关。
设计、设置和参与者：这项非随机对照试验包括参与 2017 年至 2018 年 Leapfrog 医院调查中的计算机化医嘱输入 (CPOE) 评估工具的美国医院，这是一个全国性的质量报告计划，使用模拟医嘱和患者评估医院 CDS 的安全性能。使用 sharp 回归不连续性设计来确定在随后的一年中收到负面反馈与医院绩效改进之间的关联。数据于 2020 年 1 月至 9 月进行分析。
公开报告的质量反馈。
主要结果是使用接受负面公开报告反馈与质量改进之间关联的回归不连续性模型估计，从 2017 年到 2018 年，Leapfrog CPOE 评估工具的改进情况。
共纳入 1183 家医院，基线时 CPOE 评分的平均值 (SD) 为 59.3% (16.3%)。与接受相同评估的收到积极反馈的医院相比，在随后的一年中，收到负面反馈的医院在基本 CDS 能力方面的改进幅度高出 8.44 个百分点（95%CI，0.09 至 16.80）。这种变化是由基本 CDS 能力改进方面的差异（β=8.71 [95%CI，1.67 至 18.73]）而不是高级 CDS （β=6.15 [95%CI，-9.11 至 26.83]）驱动的。
在这项非随机对照试验中，公开报告的反馈与质量改进有关，这表明针对特定领域的过程质量进行有针对性的衡量和报告可能是一项有效的政策杠杆，以鼓励改进。临床决策支持是确保患者安全和减少药物不良反应的重要工具，特别是对于复杂患者和那些在一次护理过程中经常接受多种不同药物的患者。
