Karen E Joynt1, Deepak L Bhatt2, Lee H Schwamm3, Ying Xian4, Paul A Heidenreich5, Gregg C Fonarow6, Eric E Smith7, Megan L Neely4, Maria V Grau-Sepulveda4, Adrian F Hernandez4. 1. Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Harvard School of Public Health, Boston, Massachusetts. Electronic address: kjoynt@partners.org. 2. Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. 3. Massachusetts General Hospital, Boston, Massachusetts. 4. Duke Clinical Research Institute, Durham, North Carolina. 5. Palo Alto Veterans Affairs Hospital, Palo Alto, California. 6. University of California Los Angeles, Los Angeles, California. 7. Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
Abstract
BACKGROUND: Electronic health records (EHRs) may be key tools for improving the quality of health care, particularly for conditions for which guidelines are rapidly evolving and timely care is critical, such as ischemic stroke. OBJECTIVES: The goal of this study was to determine whether hospitals with EHRs differed on quality or outcome measures for ischemic stroke from those without EHRs. METHODS: We studied 626,473 patients from 1,236 U.S. hospitals in Get With the Guidelines-Stroke (GWTG-Stroke) from 2007 through 2010, linked with the American Hospital Association annual survey to determine the presence of EHRs. We conducted patient-level logistic regression analyses for each of the outcomes of interest. RESULTS: A total of 511 hospitals had EHRs by the end of the study period. Hospitals with EHRs were larger and were more often teaching hospitals and stroke centers. After controlling for patient and hospital characteristics, patients admitted to hospitals with EHRs had similar odds of receiving "all-or-none" care (odds ratio [OR]: 1.03; 95% CI: 0.99 to 1.06; p=0.12), of discharge home (OR: 1.02; 95% CI: 0.99 to 1.04; p=0.15), and of in-hospital mortality (OR: 1.01; 95% CI: 0.96 to 1.05; p=0.82). The odds of having a length of stay>4 days was slightly lower at hospitals with EHRs (OR: 0.97; 95% CI: 0.95 to 0.99; p=0.01). CONCLUSIONS: In our sample of GWTG-Stroke hospitals, EHRs were not associated with higher-quality care or better clinical outcomes for stroke care. Although EHRs may be necessary for an increasingly high-tech, transparent healthcare system, as currently implemented, they do not appear to be sufficient to improve outcomes for this important disease.
BACKGROUND: Electronic health records (EHRs) may be key tools for improving the quality of health care, particularly for conditions for which guidelines are rapidly evolving and timely care is critical, such as ischemic stroke. OBJECTIVES: The goal of this study was to determine whether hospitals with EHRs differed on quality or outcome measures for ischemic stroke from those without EHRs. METHODS: We studied 626,473 patients from 1,236 U.S. hospitals in Get With the Guidelines-Stroke (GWTG-Stroke) from 2007 through 2010, linked with the American Hospital Association annual survey to determine the presence of EHRs. We conducted patient-level logistic regression analyses for each of the outcomes of interest. RESULTS: A total of 511 hospitals had EHRs by the end of the study period. Hospitals with EHRs were larger and were more often teaching hospitals and stroke centers. After controlling for patient and hospital characteristics, patients admitted to hospitals with EHRs had similar odds of receiving "all-or-none" care (odds ratio [OR]: 1.03; 95% CI: 0.99 to 1.06; p=0.12), of discharge home (OR: 1.02; 95% CI: 0.99 to 1.04; p=0.15), and of in-hospital mortality (OR: 1.01; 95% CI: 0.96 to 1.05; p=0.82). The odds of having a length of stay>4 days was slightly lower at hospitals with EHRs (OR: 0.97; 95% CI: 0.95 to 0.99; p=0.01). CONCLUSIONS: In our sample of GWTG-Stroke hospitals, EHRs were not associated with higher-quality care or better clinical outcomes for stroke care. Although EHRs may be necessary for an increasingly high-tech, transparent healthcare system, as currently implemented, they do not appear to be sufficient to improve outcomes for this important disease.
Authors: Jonathan R Enriquez; James A de Lemos; Shailja V Parikh; DaJuanicia N Simon; Laine E Thomas; Tracy Y Wang; Paul S Chan; John A Spertus; Sandeep R Das Journal: Circ Cardiovasc Qual Outcomes Date: 2015-10-20
Authors: Senthil Selvaraj; Gregg C Fonarow; Shubin Sheng; Roland A Matsouaka; Adam D DeVore; Paul A Heidenreich; Adrian F Hernandez; Clyde W Yancy; Deepak L Bhatt Journal: J Am Heart Assoc Date: 2018-03-30 Impact factor: 5.501