Health Informatics Research Group, Department of Business Management and Social Sciences, Osnabrück University of Applied Sciences, P.O. Box 1944, D-49009 Osnabrück, Germany.
Int J Med Inform. 2024 May;185:105394. doi: 10.1016/j.ijmedinf.2024.105394. Epub 2024 Mar 5.
Despite the improvements made in recent decades, the OECD regards hospital-acquired pressure injuries (HAPI) as high priority areas for actions to ensure patient safety. This study was aimed at investigating the degree of utilization of two types of electronic patient record systems for wound care on lowering HAPI rates. Furthermore, the effect of user satisfaction with the systems and perceived alignment with clinical processes should be studied.
A regression analysis of post-stratified data from German hospitals obtained from the Hospital Quality Reports (observed/expected HAPI ratio) and the IT Report Healthcare was performed. The sample comprised 319 hospitals reporting on digital wound record systems and 199 hospitals on digital nursing record systems for system utilization and the subset of hospitals using a digital system for user satisfaction and process alignment.
The study revealed a significant effect of hospital ownership for both types of systems and a significant interaction of ownership and system utilization for digital wound record systems: Only the for-profit hospitals benefited from a higher degree of system utilization with a lower HAPI ratio. In contrast, non-profit hospitals yielded a reversed pattern, with increasing HAPI rates matching an increased system utilization. User satisfaction (significant) and the perceived alignment of the clinical process (trend) of the digital nursing record system were related with lower HAPI ratios.
These findings point to a differential effect of system utilization on HAPI ratios depending on hospital ownership, and they demonstrate that those users who are satisfied with the system can act as catalysts for better care. The explained variance was small but comparable to other studies. Furthermore, it shows that explaining quality care is a complex undertaking. Sheer utilization has no effect while a differential perspective on the facilitators and barriers might help to explain the patient outcomes.
尽管近几十年来有所改进，经合组织仍将医院获得性压疮（HAPI）视为确保患者安全的高优先级行动领域。本研究旨在调查两种电子病历系统在降低 HAPI 发生率方面的使用程度。此外，还应研究用户对系统的满意度以及与临床流程的一致性的影响。
对德国医院的 Hospital Quality Reports（观察到的/预期的 HAPI 比值）和 IT 报告 Healthcare 的分层后数据进行回归分析。样本包括报告数字伤口记录系统的 319 家医院和报告数字护理记录系统的 199 家医院，用于系统利用，以及使用数字系统的医院子集用于用户满意度和流程一致性。
研究表明，两种系统的医院所有权都有显著影响，数字伤口记录系统的所有权和系统利用之间存在显著的相互作用：只有营利性医院从更高程度的系统利用中受益，HAPI 比值更低。相比之下，非营利性医院则呈现出相反的模式，随着系统利用率的增加，HAPI 率也随之增加。数字护理记录系统的用户满意度（显著）和临床流程的一致性（趋势）与较低的 HAPI 比值相关。
这些发现表明，系统利用对 HAPI 比值的影响因医院所有权而异，并且表明对系统满意的用户可以作为更好护理的催化剂。解释的方差虽然很小，但与其他研究相当。此外，它表明解释高质量护理是一项复杂的任务。单纯的利用没有效果，而对促进因素和障碍的不同看法可能有助于解释患者的结果。
