Hospital quality of care: does information technology matter? The relationship between information technology adoption and quality of care

BACKGROUND: Hospitals have been slow to adopt information technology (IT) largely because of a lack of generalizable evidence of the value associated with such adoption. PURPOSE: To explore the relationship between IT adoption and quality of care in acute-care hospitals. METHODS: Primary data on hospital IT adoption were combined with secondary hospital discharge data. Regression analyses were used to examine the relationship between various measures of IT adoption and several quality indicators after controlling for confounders. Adoption of IT was measured using a previously validated method that considers clinical, administrative, and strategic IT capabilities of acute-care hospitals. Quality measures included the Inpatient Quality Indicators developed by the Agency for Healthcare Research and Quality. RESULTS: Data from 98 hospitals were available for analyses. Hospitals adopted an average of 11.3 (45.2%) clinical IT applications, 15.7 (74.8%) administrative IT applications, and 5 (50%) strategic IT applications. In multivariate regression analyses, hospitals that adopted a greater number of IT applications were significantly more likely to have desirable quality outcomes on seven Inpatient Quality Indicator measures, including risk-adjusted mortality from percutaneous transluminal coronary angioplasty, gastrointestinal hemorrhage, and acute myocardial infarction. An increase in clinical IT applications was also inversely correlated with utilization of incidental appendectomy, and an increase in the adoption of strategic IT applications was inversely correlated with risk-adjusted mortality from craniotomy and laparoscopic cholecystectomy. PRACTICE IMPLICATIONS: Hospital adoption of IT is associated with desirable quality outcomes across hospitals in Florida. These findings will assist hospital leaders interested in understanding better the effect of costly IT adoption on quality of care in their institutions.     

Federal investment in health information technology: how to motivate it?

Health care market failures include inefficient standard making, problems with coordination among local providers to optimize care, and inability to measure quality accurately, inexpensively, or reliably. Study of other industries suggests policy directions for health information technology and the magnitude of gains from improving market functioning, which are very large. A perspective drawn from U.S. industrial history--in particular railroads and the interstate highway system--suggests an investment level roughly consistent with recent estimates drawn from the medical literature. The benefits of quick action probably outweigh the benefits of delaying and choosing the perfect funding mechanism.     

Valuing the benefits of publicly-provided health care: does 'ability to pay' preclude the use of 'willingness to pay'?

The case against the use of willingness to pay (WTP) methods to value the benefits of publicly-provided health care is often made on the basis that WTP is associated with ability to pay. In this paper, it is demonstrated that this argument is not so straightforward, depending on two criteria: (a) the association of people's preferences with ability to pay and (b) the disparities of WTP for given options within categories of ability to pay. A method of dealing with ability to pay, based on these criteria, is proposed and illustrated through the use of data from a case study.     

Health information technology: does it facilitate or hinder rapid learning?

Health information technology presents major challenges as well as opportunities in creating care that fulfills the Institute of Medicine's aims of being safe, timely, effective, efficient, equitable, and patient-centered. This commentary examines the barriers that relate directly to the collection and use of information in practice, and it explores some of the possible solutions. Only through concerted efforts involving major changes in the way we collect, store, analyze, and use information related to the care of patients with cancer, paired with active practice redesign and reimbursement reform, are we likely to achieve the substantial progress envisioned by Paul Wallace.     

E-business in health care: does it contribute to strengthen consumer interest?

One of the goals of the reforms in the European health-care systems over the last two decades has been to make the health-care system more demand-oriented. There is not much known about the possible impact of E-business like approaches on this goal. This paper describes the concept of E-business. Two cases are introduced to illustrate the use of a simple E-business approach in a health-care setting. On the basis of these case studies, we aspect a reduction of the information disadvantages of patients. In our analysis, we also apply new institutional economy concepts, namely agency theory and transaction costs economics to focus on the position of the patient. Concluded is that it is more probable that preferences of demanders are answered by the suppliers of health care.     

How much does health care contribute to health inequality in New Zealand?

OBJECTIVE: To quantify the contribution of health care to ethnic and socio-economic inequalities in health in New Zealand in 2000-02, using the concept of 'amenable' mortality (deaths at ages 0-74 years from causes responsive to health care). DATA SOURCES AND METHODS: Mortality data for 2000-02 were provided by the New Zealand Health Information Service and 2001 Census population data were provided by Statistics New Zealand. The classification of ICD-10 codes as amenable or non-amenable used in the Australian and New Zealand Atlas of Avoidable Mortality (2006) was adopted. Ethnicity was categorised as Maori, Pacific or European/Other. Socio-economic position was measured using a Census-based small area deprivation index, the NZDep2001. Mortality rates were standardised for age by the direct method for the ethnic group comparisons, and for both age and ethnicity for the deprivation group comparisons. The contribution of health care to health inequality was then quantified as the ratio of the difference in standardised amenable mortality rates to the difference in standardised total mortality rates (in the age group 0-74 years) between relevant groups. RESULTS: Amenable causes of death were estimated to account for 27%, 34%, 33% and 44% of the total mortality disparity (0-74 years) for Maori males, Maori females, Pacific males and Pacific females respectively, relative to their European/ Other counterparts (adjusting for age). The corresponding proportions for the 'deprived' population relative to the 'non-deprived' population were 26% (males) and 30% (females), adjusting for age and ethnicity. CONCLUSIONS: Amenable causes of death made a substantial contribution to differences in mortality in the 0-74 year age range between ethnic and socio-economic groups in New Zealand in 2000-02, ranging from 26-44% depending on the group.     

Disease management and health care reforms in Germany - does more competition lead to less solidarity?

Up to the 1990s German health care legislation was dominated by measures regulating the supply side. Measures, such as budgets, aimed at volume control and sought to confine the increase of health care spending to the growth of the national income. To curb costs more effectively, competitive elements were introduced in the 1990s with free choice of sickness funds (open enrollment). To balance competition and solidarity, a risk compensation scheme (RCS) was implemented two years prior to open enrollment. Since then, balancing competition and solidarity has been a key feature of all consecutive health care reforms. The implementation of disease management programs in the statutory health insurance (SHI) served the dual purpose to promote quality of care and to foster competition. Preliminary experiences suggest, that the aligning of disease management programs with a RCS can greatly aid its implementation and benefit solidarity and competition.     

Sympathetic listening or steamrolling? Quality in the health professional-patient relationship in light of new information technology

In the services sector, the product of labor is not a commodity that can be traded easily. What is sold is a specialized service, basically through an exchange of information to meet the client's needs and expectations. What emerge are thus the social relations between individuals: professionals and clients/consumers. This article presents evidence that the introduction of information technology undermines the quality of the relationship between the health professional and the patient. The article begins by discussing concepts pertaining to quality in the health sector. The health professional-patient relationship is then discussed through a brief review of the health/disease concept and specifically the physician-patient relationship. Analysis of primary data shows some indication that technological, physical, and management changes in health care units are undermining the quality of health care: many technological changes, but few operational changes, and many machines, but few professionals to treat patients.     

Improving the quality of health care: who will lead?

National interest in the quality of American health care increased dramatically in 1999. The press, the Institute of Medicine, legislators, physicians, and hospitals joined in a vigorous policy discussion. But a similar debate occurred in 1988, following reports from four public agencies that detailed their concerns about health care quality. In the intervening decade, research has not documented much improvement. In this paper we outline the quality problems in U.S. health care, review some of their most prominent causes, consider the biggest obstacles to bringing about major improvement, and discuss the vital role of leadership in achieving this goal.     

Integrated care pathways: pathways to change in health care?

PURPOSE: The purpose of this paper is to demonstrate that, if teams in healthcare focus on the patient using the framework of a care pathway, change can occur without the overt need to "manage" it directly. DESIGN/METHODOLOGY/APPROACH: In this paper the relevant literature is reviewed and it is demonstrated that if this approach is used it also provides a means for addressing difficult professional and organisational issues that are often unresolved in broader projects of organisational change. This is not presented as a panacea or the solution to all change projects, rather the contention here is that it is one means among many that can be used to bring about important changes in practice. FINDINGS: The paper finds that care pathways represent a useful tool, which teams can use to work through the contextual and practical issues involved in changing practice. ORIGINALITY/VALUE: The paper describes the development of integrated care pathways, which can be regarded as a fortunate fusion of managerial and professional concerns.     

Does gender make a difference? Factors that influence salary level in health information management

The article examines factors that influence salary level among health information management professionals. Specifically, it addresses questions related to whether gender makes a difference in salary level or whether factors such as education and size of the organization are important. Findings suggest that education and size of the organization are the most important factors influencing salary level. The one notable exception is among newly credentialed registered record administrators. Here, men earn more than women when education and size of the organization are controlled variables.