A dozen years ago, the seminal Dartmouth Atlas of Health Care vividly depicted wide variance in the concentration of hospitals, physician specialists, diagnoses and treatment procedures.
This month, researchers from Arizona State University published a report in Health Affairs on the levels of variance in the adoption of health information technology systems deemed to have substantial impact on patient safety.
Researchers found that IT adoption is, dare one say, all over the map.
Despite the best efforts to promote patient safety by various agencies of state and federal government and multiple private-sector organizations, including the Joint Commission, National Quality Forum and Leapfrog Group, progress remains slow in effectively addressing preventable medical errors and other patient-safety issues through IT adoption, even though, Health IT is regarded as an essential tool for hospitals navigating the road to patient safety, according to the authors of the 11-page report, Adoption of Health Information Technology for Medication Safety in U.S. Hospitals, 2006.
As a data source, lead researcher Michael Furukawa, assistant professor of health management and policy at ASU, Tempe, and his team used 2006 numbers from the database of HIMSS Analyticsthe data-mining arm of the Chicago-based Healthcare Information and Management Systems Societyand 2004 data from the American Hospital Association. They came up with a data set from 4,561 hospitals, what the authors call a near census of the universe of short-term, acute-care, general and surgical hospitals.
The researchers also tracked a multitude of demographic and geographic variables, including hospital size (by bed count); affiliations with other hospitals in a system or with the Council of Teaching Hospitals and Health Systems; accreditation by the Joint Commission; whether the hospital was run by a not-for-profit, for-profit or government organization; location by region and state; and whether that state has a patient-safety coalition, adverse-event reporting system or patient-safety center.
Based on those variables, they looked at three stages of medication-safety technologies and eight IT applicationsin medication prescribing, whether the facility had systems for electronic health records, clinical decision support and computerized physician order entry; in medication dispensing, systems for bar coding, automated dispensing machines and robotic dispensing; and in medication administration, electronic medication administration recordkeeping and bar coding at administration.
Rates of adoption vary significantly across geographic regions, the report said, with the New England, Mid-Atlantic and South Atlantic regions leading the way, and the West and Mountain states trailing. Rhode Island had the highest adoption rate per hospital, six times higher than South Dakota, the lowest.
Automated dispensing machines were the most prevalent of the eight patient-safety applications, present in nearly 62% of hospitals, while bar coding at the point of administration was the least prevalent, available at only 5% of hospitals, according to the report. Counting all eight applications across all hospitals, adoption rates were paltry, with an average of only 2.24 applications per hospital.
Perhaps the biggest seeming anomaly presented by the authors is the relationship between a hospitals Medicare and Medicaid payer mix and its rate of adoption of patient-safety IT systems.
According to the report, hospitals in the top third of Medicare share of discharges have lower rates of adoption than hospitals in the bottom third, a finding in keeping with conventional wisdom, that disproportionate-share hospitals dont have the money to invest in expensive IT systems. But the researchers found the opposite is true for Medicaid share of discharges.
We cant completely explain it, Furukawa said. I think it is the focus of Medicaid in healthcare IT, because Medicaid got a lot of IT transformation grants. Theyve been putting their weight behind adoption of health IT. Theyre really pushing it. So, the hospitals that have more Medicaid can be benefiting from more grants, and the states pushing it, but it is surprising.
Hospital size, not location or business affiliation, was the strongest predictor of the level of overall IT implementation, the researchers said. Large hospitals (200 or more beds) have 79% higher levels of overall adoption of the eight IT applications and mid-sized hospitals (50-199 beds) have 48% higher adoption levels than small hospitals of 1 to 49 beds.
Private, not-for-profit hospitals have a higher, average adoption rate across the eight IT patient-safety applications tracked (at 2.58 systems) than investor-owned hospitals (2.24) and government-owned hospitals (1.35).
Furukawa said the eastward tilt of the adoption scale has to do with a couple of factors. One of the things we did look at is the state patient-safety initiatives and when you look at it, its Pennsylvania, Florida and New York, the usual suspects (with state-mandated patient-safety programs) and theyre on the East Coast, he said. And a lot of the leading academic medical centers are in Boston and on the East Coast. Academic medical centers with histories of research in medical informatics such as Harvard and Johns Hopkins add weight to the skew, he said.
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