Electronic Health Record Use, Work Environments, and Patient Outcomes (Pennsylvania)

Project Details - Ongoing

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Summary:

The tremendous promise of electronic health records (EHRs) to improve the quality and safety of health care has gone unrealized. Hospitalized patients continue to face increased risk of adverse outcomes, including death, complications, readmissions, and substandard care. For example, estimates are that approximately one in five surgical patients experience at least one adverse event during their hospitalization, while one in seven surgical patients is readmitted to the hospital within 30 days of discharge. Although there is a growing body of literature examining the impact of technology on health care, there is little research that includes the consideration of sociotechnical factors that influence the use of technology.

This project seeks to answer a question essential to hospital administrators’ and policymakers’ decisionmaking: are good nurse work environments necessary for the success of EHR system implementation in improving the quality of patient care? The project will focus on how the work environment influences the relationship between EHR adoption and patient outcomes and seeks to determine not only whether EHR adoption is related to better outcomes, but also whether EHR effectiveness hinges upon having an organizational structure that supports professional nursing practice.

The specific aims of this project are as follows:

  • To examine the association between EHR use, nurse work environments, nurses’ evaluations of EHR effectiveness, and outcomes of patients admitted for common medical conditions or general surgery, including mortality, failure-to-rescue, readmissions, and patient safety indicators 
  • To examine whether changes in EHR use are related to changes in medical-surgical patient outcomes, including mortality, failure-to-rescue, readmissions, and patient safety indicators, and whether such changes are conditional on the nurse work environment and nurse staffing 

The study will use a retrospective, cross-sectional, and two-stage panel design to investigate the impact of EHR use on the outcomes of medical-surgical patients and determine the extent to which the nurse work environment influences these relationships. The project team anticipates finding that patients treated in hospitals with better environments and better staffing will have greater EHR use, more positive evaluations of EHR effectiveness, and better patient outcomes.

In addition, they expect that they will find that more pronounced changes in the breadth and depth of EHR use will produce greater improvements in patient outcomes, and that both changes may be conditional on nurse work environments and nurse staffing. The full advantage of EHR technology may be best realized in hospitals where nurses are supported in their practice, are involved in institutional decisionmaking regarding delivery of patient care, and have adequate staffing support.

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