Electronic health record utilization, intensity of hospital care, and patient outcomes.
Am J Med. 2013 Dec 10;
Authors: Blecker S, Goldfeld K, Park N, Shine D, Austrian JS, Braithwaite RS, Radford MJ, Gourevitch MN
BACKGROUND: Previous studies have suggested that weekend hospital care is inferior to weekday care and that this difference may be related to diminished care intensity. The purpose of this study was to determine whether a metric for measuring intensity of hospital care based on utilization of the electronic health record (EHR) was associated with patient-level outcomes.
METHODS: We performed a cohort study of hospitalizations at an academic medical center. Intensity of care was defined as the hourly number of provider accessions of the electronic health record, termed "EHR interactions." Hospitalizations were categorized based on the mean difference in EHR interactions between the first Friday and Saturday of hospitalization. We used regression models to determine the association of these categories with patient outcomes after adjusting for covariates.
RESULTS: EHR interactions decreased from Friday to Saturday in 77% of the 9,051 hospitalizations included in the study. As compared to hospitalizations with no change in Friday to Saturday EHR interactions, the relative lengths of stay for hospitalizations with a small, moderate, and large decrease in EHR interactions were 1.05 (95% CI 1.00-1.10), 1.11 (95% CI 1.05-1.17), and 1.25 (95% CI 1.15-1.35), respectively. Although a large decrease in EHR interactions was associated with in-hospital mortality, these findings were not significant after risk adjustment (odds ratio 1.74, 95% CI 0.93-3.25).
CONCLUSIONS: Intensity of inpatient care, measured by EHR interactions, significantly diminished from Friday to Saturday, and this decrease was associated with length of stay. Hospitals should consider monitoring and correcting temporal fluctuations in care intensity.
PMID: 24333204 [PubMed - as supplied by publisher]