Impact of Heath Information Technology on Delivery and Quality of Patient Care - Final Report

Purpose: The study purpose was to examine the relationships among: (1) EHR adoption stage, (2) missed nursing care and (3) nursing practice environment, on hospitalized patient adverse outcomes and satisfaction. Scope: The analytic sample consisted of data on 854,258 adult patients discharged from 70 New Jersey hospitals in 2006 and 7,679 nurses working in those same hospitals. Methods: This secondary analysis of cross sectional data was compiled from four sources: (1) State Inpatient Database (SID) from the Healthcare Cost Utilization Project (HCUP); (2) Healthcare Information and Management Systems Society (HIMSS) Dorenfest Institute; (3) Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) and (4) New Jersey nurse survey data. The analytic approach used ordinary least squares and multiple regression models to estimate the effects of EHR adoption stage on the delivery of nursing care and patient outcomes, controlling for characteristics of patients, nurses, and hospitals. Robust procedures with Huber-White sandwich variance estimators and clustered means were used to account for the clustering of patients within hospitals. Results: Significant findings from this study indicate positive relationships between nursing practice environment and patient satisfaction, and inverse relationships between: (a) advanced EHR adoption and adverse outcome of prolonged length of stay, (b) nursing practice environment and missed nursing care and (c) missed nursing care and patient satisfaction. Further, findings indicate strong, significant relationships among staffing and resource adequacy, missed nursing care and patient satisfaction, and that these strong relationships are not confounding the effects of EHR adoption stage on patient satisfaction.