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Clinical Information Technologies and Inpatient OutcomesA Multiple Hospital Study
Ruben Amarasingham, MD, MBA;
Laura Plantinga, ScM;
Marie Diener-West, PhD;
Darrell J. Gaskin, PhD;
Neil R. Powe, MD, MPH, MBA
Arch Intern Med. 2009;169(2):108-114.
Background Despite speculation that clinical information technologies will improve clinical and financial outcomes, few studies have examined this relationship in a large number of hospitals.
Methods We conducted a cross-sectional study of urban hospitals in Texas using the Clinical Information Technology Assessment Tool, which measures a hospital's level of automation based on physician interactions with the information system. After adjustment for potential confounders, we examined whether greater automation of hospital information was associated with reduced rates of inpatient mortality, complications, costs, and length of stay for 167 233 patients older than 50 years admitted to responding hospitals between December 1, 2005, and May 30, 2006.
Results We received a sufficient number of responses from 41 of 72 hospitals (58%). For all medical conditions studied, a 10-point increase in the automation of notes and records was associated with a 15% decrease in the adjusted odds of fatal hospitalizations (0.85; 95% confidence interval, 0.74-0.97). Higher scores in order entry were associated with 9% and 55% decreases in the adjusted odds of death for myocardial infarction and coronary artery bypass graft procedures, respectively. For all causes of hospitalization, higher scores in decision support were associated with a 16% decrease in the adjusted odds of complications (0.84; 95% confidence interval, 0.79-0.90). Higher scores on test results, order entry, and decision support were associated with lower costs for all hospital admissions (–$110, –$132, and –$538, respectively; P < .05).
Conclusion Hospitals with automated notes and records, order entry, and clinical decision support had fewer complications, lower mortality rates, and lower costs.
Author Affiliations: Center for Knowledge Translation and Clinical Innovation, Parkland Health & Hospital System and Department of Medicine, University of Texas Southwestern Medical Center, Dallas (Dr Amarasingham); Departments of Epidemiology (Ms Plantinga and Dr Powe), Biostatistics (Dr Diener-West), and Health Policy and Management (Dr Powe), Bloomberg School of Public Health, and Department of Medicine (Dr Powe) and Welch Center for Prevention, Epidemiology, and Clinical Research (Ms Plantinga and Dr Powe), The Johns Hopkins University School of Medicine, Baltimore, Maryland; and Department of African American Studies, University of Maryland, College Park (Dr Gaskin).
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