For whatever reason, there is a correlation between the use of high-end clinical information systems and a broad improvement in patient safety and improved outcomes at hospitals participating in the Leapfrog Group quality-improvement initiative, according to a study by a group of researchers from the Harvard School of Public Health and 746-bed Brigham and Womens Hospital, Boston.
The eight-page report on their research, Does the Leapfrog program help identify high-quality hospitals? was published in the June issue of the Joint Commission Journal on Quality and Patient Safety.
Ashish Jha, an assistant professor in the Health Policy and Management Department at the Harvard School of Public Health and a staff physician at Veteran Affairs Healthcare System, Boston, was the lead author of the report. The research was funded by the Commonwealth Fund, New York, and Jha received individual support from the Robert Wood Johnson Foundation.
Jha and colleagues looked at all three fundamental leaps originally promoted by the Leapfrog Groupthe increased use of hospital-based intensivists, a reliance on evidence-based referrals and the adoption of computerized physician order-entry systemsat 1,860 hospitals targeted by Leapfrog due to significant utilization by employees of Leapfrog member organizations.
We were interested in all these different rating systems that have come out, from Leapfrog and others, Jha said. The idea was to determine whether adherence to the quality measures chosen by these organizations actually mattered in terms of increased patient safety and better outcomes. Jha said they chose Leapfrog because of its prominence among the various improvement efforts.
Based on data reported to the Hospital Quality Alliance, quality and safety for acute myocardial infarction, congestive heart failure and pneumonia improved in correlation to adoption and adherence to the Leapfrog targets across all three leaps, Jha said.
The bottom line is that we found that hospitals that implement CPOE have higher quality of care and better mortality rates than hospitals that have not, he said.
According to the report, for example, hospitals with CPOE had better scores for AMI than those that either did not have CPOE or chose not to report their results.
But was that because they used CPOE or because they were better hospitals all-around?
The answer is, I dont know, Jha said. The reality is, I think, clearly to some extent its about better hospitals that happen to have CPOE. The hospitals that are focused on quality and safety are more likely to invest in CPOE.
The quality was worse among those who didnt invest in CPOE, and it was better for those that started to invest in it, and better for those that are a little bit farther along, and better for those that are fully invested. When you see this graded relationship there probably is some benefit from investing in CPOE, but our study couldnt tease those apart. It still remains in question, Jha said.