Improving Safety and Quality with Integrated Technology (Oregon)

Project Final Report (PDF, 171.85 KB) Disclaimer

Project Details - Ended

Project Categories

Summary:

Discontinuities in clinical information systems pose a large problem for everyday clinical practices. Although care for patients spans outpatient and inpatient settings, clinical information systems, until recently, have focused on either outpatient or inpatient systems, but not both. This project aimed to demonstrate the value of an integrated outpatient and inpatient health information system to improve quality of health care and patient safety.

There are many examples of conditions that cause patients to transition across outpatient and inpatient settings, including diabetes, asthma, and congestive heart disease. Pregnancy is an ideal situation to test the hypothesis that integration makes a difference, since 4 million women annually transition across outpatient and inpatient settings. The investigators of this project chose a common and potentially life threatening condition, group B streptococcus (GBS), to demonstrate the value of an integrated data system. The specific aims of the project were to:

  1. Demonstrate the value of an integrated outpatient and inpatient health information technology system to improve quality of care and safety for women and infants;
  2. Demonstrate the value of an electronic alert system to increase GBS screening in the outpatient setting; and
  3. Perform a policy analysis comparing the costs and implications for GBS screening according to United States, Canadian, and United Kingdom policies to inform health care delivery and obstetric safety discussions.

This project demonstrated that an integrated outpatient and inpatient data system has considerable value to improving patient safety, including an increase in documentation completeness and communication of important clinical information to other providers. The investigators also found an improvement in timely access to time-critical information, and decision support to promote safe care practices related to GBS screening and treatment. Additionally, the breadth of data allowed the investigators to perform a policy analysis comparing Canadian, U.S., and U.K. screening and management policies for GBS and the costs relating to each. Such data are very informative to the discussion surrounding the safe and cost efficient redesign of the U.S. health care delivery system.

Improving Safety and Quality with Integrated Technology - 2009

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    RFA: HS04-012: Demonstrating the Value of Health Information Technology (THQIT)
  • Grant Number: 
    R01 HS 015321
  • Project Period: 
    September 2004 – August 2009, Including No-Cost Extension
  • AHRQ Funding Amount: 
    $1,461,150
  • PDF Version: 
    (PDF, 1.01 MB)


Target Population: Women*: Pregnant Women

Summary: The project sought to demonstrate the value of integrating the State Obstetric and Pediatric Research Collaboration (STORC), an inpatient and outpatient electronic health record (EHR), with an electronic alert system in improving quality of health care and patient safety. Obstetrics (OB) was chosen as the health care setting because pregnant women inevitably transition between inpatient and outpatient settings in a matter of months.

Evidence-based treatment guidelines have been developed to improve the identification and treatment of Group B Streptococcus (GBS), a common and potentially life-threatening condition. The implementation includes alerts to increase the likelihood of patient screening and decrease the unnecessary prescription of antibiotics for women who are GBS-negative.

The project team evaluated the impact of the integrated system on patient safety and quality of care with a mixed-methods approach that included a work-sampling study to examine medical staff workflow, a before-and-after chart review to examine documentation of key information, and a prospective intervention study to examine the effect on GBS screening rates.

This project demonstrated that an integrated outpatient and inpatient data system can improve patient safety. The project team found that there was improvement in access to time-critical information and decision support to promote safe care practices relating to GBS screening and treatment. Additionally, the breadth of data supported a policy analysis comparing Canadian, United States, and United Kingdom screening and management policies for GBS and the costs relating to each. Such data are critical for the discussion about the safe and cost-effective redesign of the U.S. health care delivery system. The findings, though applied specifically to OB, can be applied to many areas of medicine and surgery and may inform stakeholders making decisions regarding other health information technology (IT) systems in both inpatient and outpatient settings.

Specific Aims:

  • Demonstrate the value of an integrated outpatient and inpatient EHR to improve quality of care and safety for women and infants. (Achieved)
  • Demonstrate the value of an electronic alert system to increase GBS screening in the outpatient setting. (Achieved)
  • Perform a policy analysis comparing the costs and implications for GBS screening according to the United States, Canadian, and United Kingdom policy to inform health care delivery and obstetric safety discussions. (Achieved)

2009 Activities: A policy analysis compared the costs and implications of United States, Canadian, and United Kingdom policies for GBS screening. Results informed health care delivery and obstetric safety discussions. Two decision models were created to evaluate the policies. The first model, “optimal treatment,” used Oregon Health and Science University (OHSU) data to provide probabilities for GBS +, GBS–, and unknown status, GBS risk factors, and the frequencies of different types of medications and their associated costs. The second model displays the actual treatment paths and probabilities and was created subsequently.

Grantee’s Most Recent Self-Reported Quarterly Status (as of August 2009): The project received a no-cost extension that allowed for completion of project aims and spending of budget.

Impact and Findings: Analysis found that between October 2004, when paper records were used, and March 2008, when a fully-integrated inpatient and outpatient EHR with an outpatient alert system for GBS screening was in place, the rate of patients missing GBS lab results dropped from 11 to 6 percent for Oregon Health and Science University (OHSU) patients. In addition, the proportion of the patients without GBS labs who delivered at OHSU but received prenatal care elsewhere increased from 22 to 28 percent. These findings suggest that improvements in compliance with clinical guidelines at OHSU were a significant factor in the change. Final results also found that the implementation of an integrated inpatient and outpatient EHR with outpatient alert system increased one-on-one time of clinical staff and patients.

Preliminary results from a survey evaluating the impact of the integrated EHR with outpatient alert system on clinical practice and satisfaction found that providers frequently or always felt that the nonintegrated EHR records were missing important OB information (45.9 percent nonintegrated EHR vs. 9.5 percent integrated EHR), and that use of the decision support tools was high, especially with the dating calculator (84.9 percent), guidelines (57.6 percent), and Bishop’s calculator (66.7 percent). Key features of the integrated EHR that providers would most hate to lose include data pulling forward into notes (71.4 percent) and the problem list (76.1 percent).

This study provides several results to inform both health IT and health care delivery discussions. The introduction of a clinical information system into a busy labor and delivery setting did not reduce the amount of time providers spent in direct patient care activities and, in fact, increased direct patient care activities. This study also demonstrated that the integrated system improved documentation completeness and communication of important clinical information to other providers and demonstrated the incremental gains in patient safety achieved with each level of health IT integration. Structured clinical data also inform health care policy decisionmaking by modeling the implications and costs of various countries’ GBS-related health care policies.

More detail on the project findings is included in Dr. Guise’s final report: Guise 2009 Final Report.

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Synthesis and Dissemination

*AHRQ Priority Population.

Improving Safety and Quality with Integrated Technology - Final Report

Citation:
Guise JM. Improving Safety and Quality with Integrated Technology - Final Report. (Prepared by Oregon Health and Science University under Grant No. R01 HS015321). Rockville, MD: Agency for Healthcare Research and Quality, 2009. (PDF, 171.85 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
Principal Investigator: 
Document Type: 
Population: 
Medical Condition: 
This project does not have any related resource.
This project does not have any related survey.
This project does not have any related project spotlight.
This project does not have any related survey.
This project does not have any related story.
This project does not have any related emerging lesson.