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Electronic Health Records and Stroke | Journal Scan
Study Questions:
Do hospitals with an electronic health record (EHR) differ on quality or outcome measures for ischemic stroke care from those without an EHR?
Methods:
Using the Get With The Guidelines-Stroke database, 626,473 patients at 1,236 US hospitals were identified between 2007 and 2010. Hospital EHR status was identified through the American Hospital Association annual survey. Patient-level logistic regression analyses were performed for each outcome of interest with hospital random effects and patient-level characteristics. The primary quality and clinical outcomes of interest included a composite “all-or-none” quality performance measure, length of stay for >4 days, discharge to home, and in-hospital mortality.
Results:
Of the 1,236 hospitals identified, 511 had an EHR by the end of the study period (increase from 8.7% in 2007 to 38.4% in 2010). These hospitals were larger (median 310 vs. 267 beds, p < 0.001), and more often teaching hospitals and certified stroke centers. After controlling for patient and hospital characteristics, patients admitted to hospitals with EHRs had similar odds of receiving “all-or-none” care (87.9% vs. 82.6%, odds ratio [OR], 1.03; 95% confidence interval [CI], 0.99-1.06), home discharge (50.9% vs. 51.1%, OR, 1.02; 95% CI, 0.99-1.04), and in-hospital mortality (5.3% vs. 5.2%, OR, 1.01; 95% CI, 0.96-1.05). The odds of having a hospital length of stay >4 days was minimally lower in EHR hospitals (42.4% vs. 43.9%, OR, 0.97; 95% CI, 0.95-0.99).
Conclusions:
The authors concluded that in their sample of Get With The Guidelines-Stroke hospitals, the presence of an EHR was not associated with higher-quality care or better clinical outcomes for stroke care.
Perspective:
The authors demonstrate that hospitals using EHR for patient care did not have significantly increased odds of achieving high-quality care for stroke patients as compared to hospitals without an EHR. This is particularly timely given inclusion of financial incentives for ‘meaningful use’ of an EHR included in the Affordable Care Act. It is important to note that over 80% of stroke patients received ‘all-or-none’ high-quality care across all hospitals. This paper suggests that strategies other than implementation of an EHR are likely required to further improve the delivery of stroke care.
Keywords: American Hospital Association, Data Collection, Electronic Health Records, Hospital Mortality, Hospitals, Teaching, Length of Stay, Logistic Models, Meaningful Use, Outcome Assessment, Health Care, Patient Discharge, Patient Protection and Affordable Care Act, Quality of Health Care, Stroke
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