TY - JOUR
T1 - Lack of impact of electronic health records on quality of care and outcomes for ischemic stroke
AU - Joynt, Karen E.
AU - Bhatt, Deepak L.
AU - Schwamm, Lee H.
AU - Xian, Ying
AU - Heidenreich, Paul A.
AU - Fonarow, Gregg C.
AU - Smith, Eric E.
AU - Neely, Megan L.
AU - Grau-Sepulveda, Maria V.
AU - Hernandez, Adrian F.
N1 - Funding Information:
The Get With the Guidelines-Stroke (GWTG-Stroke) program is provided by the American Heart Association/American Stroke Association. GWTG-Stroke was previously funded through support from Boehringer Ingelheim , Merck , Bristol-Myers Squibb/Sanofi Pharmaceutical Partnership , Janssen Pharmaceuticals , and the American Heart Association Pharmaceutical Roundtable . The funders and former funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. Dr. Bhatt has served on advisory boards for Cardax and Regado Biosciences; and has received research funding from Amarin , AstraZeneca , Bristol-Myers Squibb , Eisai , Ethicon , Forest Laboratories , Ischemix , Medtronic , Pfizer , Roche , Sanofi , and The Medicines Company . Dr. Hernandez has received grant funding from Bristol-Myers Squibb , Janssen Pharmaceuticals , Portola Pharmaceuticals , Medtronic , Novartis , and The Medicines Company ; and has received honoraria from AstraZeneca, Bristol-Myers Squibb, Janssen Pharmaceuticals, Novartis, and Gilead. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. William Weintraub, MD, served as Guest Editor for this paper.
Publisher Copyright:
© 2015 American College of Cardiology Foundation.
PY - 2015/5/12
Y1 - 2015/5/12
N2 - 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.
AB - 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.
KW - hospital mortality
KW - length of stay
KW - medical order entry systems
KW - outcome assessment (health care)
KW - registries
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U2 - 10.1016/j.jacc.2015.02.059
DO - 10.1016/j.jacc.2015.02.059
M3 - Article
C2 - 25953748
AN - SCOPUS:84928957618
SN - 0735-1097
VL - 65
SP - 1964
EP - 1972
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 18
ER -