Hospital quality of care: Does information technology matter? The relationship between information technology adoption and quality of care

Background: Hospitals have been slow to adopt information technology (IT) largely because of a lack of generalizable evidence of the value associated with such adoption. Purpose: To explore the relationship between IT adoption and quality of care in acute-care hospitals. Methods: Primary data on hospital IT adoption were combined with secondary hospital discharge data. Regression analyses were used to examine the relationship between various measures of IT adoption and several quality indicators after controlling for confounders. Adoption of IT was measured using a previously validated method that considers clinical, administrative, and strategic IT capabilities of acute-care hospitals. Quality measures included the Inpatient Quality Indicators developed by the Agency for Healthcare Research and Quality. Results: Data from 98 hospitals were available for analyses. Hospitals adopted an average of 11.3 (45.2%) clinical IT applications, 15.7 (74.8%) administrative IT applications, and 5 (50%) strategic IT applications. In multivariate regression analyses, hospitals that adopted a greater number of IT applications were significantly more likely to have desirable quality outcomes on seven Inpatient Quality Indicator measures, including risk-adjusted mortality from percutaneous transluminal coronary angioplasty, gastrointestinal hemorrhage, and acute myocardial infarction. An increase in clinical IT applications was also inversely correlated with utilization of incidental appendectomy, and an increase in the adoption of strategic IT applications was inversely correlated with risk-adjusted mortality from craniotomy and laparoscopic cholecystectomy. Practice Implications: Hospital adoption of IT is associated with desirable quality outcomes across hospitals in Florida. These findings will assist hospital leaders interested in understanding better the effect of costly IT adoption on quality of care in their institutions.

[1]  C. McDonald.  Protocol-based computer reminders, the quality of care and the non-perfectability of man. , 1976, The New England journal of medicine.

[2]  J E Smith,et al.  Use of bar codes in inpatient drug distribution. , 1991, American journal of hospital pharmacy.

[3]  Richard P. Lewis,et al.  ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). , 1996, Journal of the American College of Cardiology.

[4]  J. Marc Overhage,et al.  Research Paper: A Randomized Trial of "Corollary Orders" to Prevent Errors of Omission , 1997, J. Am. Medical Informatics Assoc..

[5]  Parag C. Pendharkar,et al.  Management of information technology and quality performance in health care facilities , 1999 .

[6]  Eta S. Berner,et al.  Effects of a decision support system on physicians' diagnostic performance. , 1999, Journal of the American Medical Informatics Association : JAMIA.

[7]  D. Bates,et al.  Improving response to critical laboratory results with automation: results of a randomized controlled trial. , 1999, Journal of the American Medical Informatics Association : JAMIA.

[8]  D. Troiano.  A primer on pharmacy information systems. , 1999, Journal of healthcare information management : JHIM.

[9]  Rajiv Kohli,et al.  Information Technology Payoff in the Health-Care Industry: A Longitudinal Study , 2000, J. Manag. Inf. Syst..

[10]  William M. Tierney,et al.  Improving clinical decisions and outcomes with information: a review , 2001, Int. J. Medical Informatics.

[11]  CPOE reduces number of steps in medication-use process. , 2001, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[12]  Alastair Baker,et al.  Crossing the Quality Chasm: A New Health System for the 21st Century , 2001, BMJ : British Medical Journal.

[13]  D. Bates,et al.  Medication errors and adverse drug events in pediatric inpatients. , 2001, JAMA.

[14]  J. Marc Overhage,et al.  Research Paper: Controlled Trial of Direct Physician Order Entry: Effects on Physicians' Time Utilization in Ambulatory Primary Care Internal Medicine Practices , 2001, J. Am. Medical Informatics Assoc..

[15]  D. Bates,et al.  How can information technology improve patient safety and reduce medication errors in children's health care? , 2001, Archives of pediatrics & adolescent medicine.

[16]  C. Bailey.  Medication Errors and Adverse Drug Events in Pediatric Inpatients , 2002 .

[17]  P. Maurette,et al.  [To err is human: building a safer health system]. , 2002, Annales francaises d'anesthesie et de reanimation.

[18]  Candice Willette,et al.  Using BCMA software to improve patient safety in Veterans Administration Medical Centers. , 2002, Journal of healthcare information management : JHIM.

[19]  I. Fraser.  Guide to Inpatient Quality Indicators: Quality of Care in Hospitals – Volume, Mortality, and Utilization , 2002 .

[20]  Rajiv Kohli,et al.  Performance Impacts of Information Technology: Is Actual Usage the Missing Link? , 2003, Manag. Sci..

[21]  Matthew B Weinger,et al.  Changes in intensive care unit nurse task activity after installation of a third-generation intensive care unit information system , 2003, Critical care medicine.

[22]  L. Moody,et al.  Electronic Health Records Documentation in Nursing: Nurses' Perceptions, Attitudes, and Preferences , 2004, Computers, informatics, nursing : CIN.

[23]  L. Moody,et al.  Electronic Health Records Documentation in Nursing , 2004 .

[24]  Mark L. Diana,et al.  Exploring Hospitals' Adoption of Information Technology , 2002, Journal of Medical Systems.

[25]  K. Eagle,et al.  Impact of Combination Evidence-Based Medical Therapy on Mortality in Patients With Acute Coronary Syndromes , 2004, Circulation.

[26]  M. Hatcher.  Impact of Information Systems on Acute Care Hospitals: Results from a Survey in the United States , 1998, Journal of Medical Systems.

[27]  Nir Menachemi,et al.  Opening the Black Box: Measuring Hospital Information Technology Capability , 2004, Health care management review.

[28]  A. Localio,et al.  Role of computerized physician order entry systems in facilitating medication errors. , 2005, JAMA.

[29]  Scott Zeger,et al.  Relationship Between Performance Measurement and Accreditation: Implications for Quality of Care and Patient Safety , 2005, American journal of medical quality : the official journal of the American College of Medical Quality.

[30]  Ralph R. Grams,et al.  A primary care application of an integrated computer-based pharmacy system , 2005, Journal of Medical Systems.

[31]  Marilyn D Paterno,et al.  Electronic alerts to prevent venous thromboembolism among hospitalized patients. , 2005, The New England journal of medicine.

[32]  Thomas T H Wan,et al.  Factors Influencing Health Information System Adoption in American Hospitals , 2005, Health care management review.

[33]  W. Encinosa,et al.  Hospital Finances and Patient Safety Outcomes , 2005, Inquiry : a journal of medical care organization, provision and financing.

[34]  R. Van Horn,et al.  Valuing Hospital Investment in Information Technology: Does Governance Make a Difference? , 2006, Health care financing review.

[35]  Eta S Berner,et al.  Improving ambulatory prescribing safety with a handheld decision support system: a randomized controlled trial. , 2006, Journal of the American Medical Informatics Association : JAMIA.

[36]  P. Shekelle,et al.  Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care , 2006, Annals of Internal Medicine.

[37]  Bryan J Weiner,et al.  Quality improvement implementation and hospital performance on quality indicators. , 2006, Health services research.

[38]  William M. Tierney,et al.  Requiring physicians to respond to computerized reminders improves their compliance with preventive care protocols , 1993, Journal of General Internal Medicine.

[39]  Anol Bhattacherjee,et al.  The Differential Performance Effects of Healthcare Information Technology Adoption , 2006, Inf. Syst. Manag..

[40]  Feliciano B. Yu,et al.  Do "most wired" hospitals deliver better care? , 2007, Joint Commission journal on quality and patient safety.