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DOI: 10.1055/s-0038-1653970
Interdisciplinary Plans of Care, Electronic Medical Record Systems, and Inpatient Mortality
Publikationsverlauf
05. April 2018
05. April 2018
Publikationsdatum:
18. Mai 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00034447/201801/lookinside/thumbnails/10-1055-s-0038-1653970_180007oa-1.jpg)
Abstract
Background Interdisciplinary plans of care (IPOCs) guide care standardization and satisfy accreditation requirements. Yet patient outcomes associated with IPOC usage through an electronic medical record (EMR) are not present in the literature. EMR systems facilitate the documentation of IPOC use and produce data to evaluate patient outcomes.
Objectives This article aimed to evaluate whether IPOC-guided care as documented in an EMR is associated with inpatient mortality.
Methods We contrasted whether IPOC-guided care was associated with a patient being discharged alive. We further tested whether the association differed across strata of acuity levels and overall frequency of IPOC usage within a hospital.
Results Our sample included 165,334 adult medical/surgical discharges for a 12-month period for 17 hospitals. All hospitals had 1 full year of EMR use antedating the study period. IPOCs guided care in 85% (140,187/165,334) of discharges. When IPOCs guided care, 2.1% (3,009/140,187) of admissions ended with the patient dying while in the hospital. Without IPOC-guided care, 4.3% (1,087/25,147) of admissions ended with the patient dying in the hospital. The relative likelihood of dying while in the hospital was lower when IPOCs guided care (odds ratio: 0.45; 99% confidence interval: 0.41–0.50).
Conclusion In this observational study within a quasi-experimental setting of 17 community hospitals and voluntary usage, IPOC-guided care is associated with a decreased likelihood of patients dying while in the hospital.
Clinical Relevance Statement
IPOC use as documented in an EMR improves patient mortality. The higher the risk of death, the greater the improvement.
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References
- 1 Hospital Accreditation Standards. Oakbrook Terrace, IL: Joint Commission Resources; 2009
- 2 CMS Regulations. Available at: www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2013-Transmittals-Items/R84SOMA.html
- 3 Talec P, Gaujoux S, Samama CM. Early ambulation and prevention of post-operative thrombo-embolic risk. J Visc Surg 2016; 153 (6S): S11-S14
- 4 Baram D, Daroowalla F, Garcia R. , et al. Use of the All Patient Refined-Diagnosis Related Group (APR-DRG) risk of mortality score as a severity adjustor in the medical ICU. Clin Med Circ Respirat Pulm Med 2008; 2: 19-25
- 5 Thomas JW, Hofer TP. Accuracy of risk-adjusted mortality rate as a measure of hospital quality of care. Med Care 1999; 37 (01) 83-92
- 6 Hall MJ, Levant S, DeFrances CJ. Trends in inpatient hospital deaths: national hospital discharge survey, 2000–2010. NCHS Data Brief 2013; (118) 1-8
- 7 Blumenthal D. Launching HITECH. N Engl J Med 2010; 362 (05) 382-385
- 8 Doolan DF, Bates DW, James BC. The use of computers for clinical care: a case series of advanced U.S. sites. J Am Med Inform Assoc 2003; 10 (01) 94-107
- 9 Amarasingham R, Plantinga L, Diener-West M, Gaskin DJ, Powe NR. Clinical information technologies and inpatient outcomes: a multiple hospital study. Arch Intern Med 2009; 169 (02) 108-114
- 10 Berner ES. Clinical decision support systems: state of the art. AHRQ Publication No. 09-0069-EF. Rockville, MD: Agency for Healthcare Research and Quality; ; June 2009
- 11 Moja L, Kwag KH, Lytras T. , et al. Effectiveness of computerized decision support systems linked to electronic health records: a systematic review and meta-analysis. Am J Public Health 2014; 104 (12) e12-e22
- 12 Jones KL, Jamerson C, Pike S. The journey to electronic interdisciplinary care plans. Nurs Manage 2012; 43 (12) 9-12
- 13 Brokel JM, Harrison MI. Redesigning care processes using an electronic health record: a system's experience. Jt Comm J Qual Patient Saf 2009; 35 (02) 82-92
- 14 Brokel JM, Schwichtenberg TJ, Wakefield DS, Ward MM, Shaw MG, Kramer JM. Evaluating clinical decision support rules as an intervention in clinician workflows with technology. Comput Inform Nurs 2011; 29 (01) 36-42
- 15 Brokel JM, Shaw MG, Nicholson C. Expert clinical rules automate steps in delivering evidence-based care in the electronic health record. Comput Inform Nurs 2006; 24 (04) 196-205 , quiz 206–207
- 16 Brokel JM, Ward MM, Wakefield DS, Ludwig A, Schwichtenberg T, Atherton D. Changing patient care orders from paper to computerized provider order entry-based process. Comput Inform Nurs 2012; 30 (08) 417-425
- 17 Lewis C, Hoffmann ML, Gard A, Coons J, Bichinich P, Euclid J. Development and implementation of an interdisciplinary plan of care. J Healthc Qual 2005; 27 (01) 15-23
- 18 Gardiner JC, Reed PL, Bonner JD, Haggerty DK, Hale DG. Incidence of hospital-acquired pressure ulcers - a population-based cohort study. Int Wound J 2016; 13 (05) 809-820
- 19 Roberts L, Ward MM, Brokel JM, Wakefield DS, Crandall DK, Conlon P. Methodological approaches to measuring the effects of implementation of health information technology (HIT). In: System Sciences, 2009. HICSS '09. 42nd Hawaii International Conference on System Sciences; January 5–8, 2009; Big Island, HI. IEEE; 2009:1–10