Relationship Between Hospital Performance Measures and 30-Day Readmission Rates

Medical errors occur at the prescription step due to lack adequate knowledge of medications by the physician, failure to adhere to policies and procedures, memory lapses, confusion in nomenclature, and illegible handwriting. Unfortunately, these errors can lead to patient readmission within 30 days of dismissal. Hospital leaders lose 0.25% to 1% of Medicare’s annual reimbursement for a patient readmitted within 30 days for the same illness. United States, lawmakers posited the use of health information technology, such as computerized physician order entry scores systems (CPOES), reduced hospital readmission, improved the quality of service, and reduced the cost of healthcare. Grounded in systems theory, the purpose of this correlational study was to examine the relationship between computerized physician order entry scores, medication reconciliation scores, and 30-day readmission rates. Archival data were collected from 117 hospitals in the southeastern region of the United States. Using multiple linear regression to analyze the data, the model as a whole did not significantly predict 30-day hospital readmission rate, F (2, 114) = 1.928, p = .150, R2 = .033. However, medical reconciliation scores provided a slightly higher contribution to the model (β = .173) than CPOES (β = .059. The implications for positive social change included the potential to provide hospital administrators with a better understanding of factors that may relate to 30-day readmission rates. Patients stand to benefit from improved service, decreased cost, and quality of healthcare

Predictive Relationships Between Electronic Health Records Attributes and Meaningful Use Objectives

The use of electronic health records (EHR) has the potential to improve relationships between physicians and patients and significantly improve care delivery. The purpose of this study was to analyze the relationships between hospital attributes and EHR implementation. The research design for this study was the cross-sectional approach. Secondary data from the Health Information and Management Systems Society (HIMSS) Analytics Database was utilized (n = 169) in a correlational crosssectional research design. Normalization Process Theory (NPT) and implementation theory were the theoretical underpinnings used in this study. Multiple linear regressions results showed statistically significant relationships between the 4 independent variables (region, ownership status, number of staffed beds [size], and organizational control) and the outcomes for the dependent variables of EHR software application attributes (Clinical Decision Support Systems (CDSS) components), EHR software application attributes (major systems), and successful implementation of Meaningful Use (MU) (p = .001). A statistically significant relationship (p = .001) was also found between the 2 independent variables (EHR software application attributes [CDSS components] and EHR software application attributes [major systems]) and the outcome of successful implementation of MU when combined. This evidence should provide policy makers and health practitioners support for their attempts to implement EHR systems to result in positive Meaningful Use which has been shown to be more cost effective and result in better quality of care for patients.The potential social change is improved medication prescribing and administration for hospitals and, lower cost and better quality of care for patients

Improving Computerized Provider Order Entry Usage in a Community Hospital

The healthcare industry is now faced with the balance between instituting computerized technology and providing safe, high quality, efficient, and lower cost patient care. An important aspect of computer technology is the direct entry of orders electronically by providers into the electronic health record, termed computerized provider order entry (CPOE). This translational research project begins by defining CPOE and discussing CPOE’s effect on patient safety and quality of care by reducing preventable medical errors and adverse drug events and CPOE’s effect on healthcare costs. Regulatory requirements pertaining to CPOE are discussed; providers are expected to be proficient in CPOE in order to meet these requirements. A literature review of barriers to CPOE usage, interventions to implement and improve usage of CPOE, and trends in CPOE usage is conducted and discussed. The purpose of this quality improvement project was to improve CPOE medication order usage among providers within a community hospital by utilizing the provider order entry user satisfaction and usage survey (POEUSUS) to identify barriers to the utilization of CPOE and by employing the technology acceptance model (TAM) and the provision of a CPOE facilitator on the patient care units for twelve hours per week for eight weeks. At the conclusion of the eight-week intervention, the CPOE utilization rates were determined and followed over an eight week interval and were compared to pre-intervention rates. Additionally, providers’ rated their satisfaction of the CPOE facilitator by completing a facilitator survey after each assistance session. The results of this project demonstrated an increase in CPOE medication order usage, from 45.4% CPOE medication order usage during the eight-week pre-intervention period to 55.6% CPOE medication order usage during the eight-week post-intervention period. A statistically significant improvement in provider CPOE satisfaction occurred after the intervention, and providers expressed high degrees of satisfaction with the real-time assistance of the CPOE facilitator. Aspects of CPOE admired by providers and recommendations of providers to changes in CPOE were determined. Finally, age was inversely related and previous computer experiment was positively related to CPOE medication order usage pre-intervention, meaning that younger providers and providers with more computer experience used CPOE more often

Systematic review of the safety of medication use in inpatient, outpatient and primary care settings in the Gulf Cooperation Council countries

Background Errors in medication use are a patient safety concern globally, with different regions reporting differing error rates, causes of errors and proposed solutions. The objectives of this review were to identify, summarise, review and evaluate published studies on medication errors, drug related problems and adverse drug events in the Gulf Cooperation Council (GCC) countries. Methods A systematic review was carried out using six databases, searching for literature published between January 1990 and August 2016. Research articles focussing on medication errors, drug related problems or adverse drug events within different healthcare settings in the GCC were included. Results Of 2094 records screened, 54 studies met our inclusion criteria. Kuwait was the only GCC country with no studies included. Prescribing errors were reported to be as high as 91% of a sample of primary care prescriptions analysed in one study. Of drug-related admissions evaluated in the emergency department the most common reason was patient non-compliance. In the inpatient care setting, a study of review of patient charts and medication orders identified prescribing errors in 7% of medication orders, another reported prescribing errors present in 56% of medication orders. The majority of drug related problems identified in inpatient paediatric wards were judged to be preventable. Adverse drug events were reported to occur in 8.5–16.9 per 100 admissions with up to 30% judged preventable, with occurrence being highest in the intensive care unit. Dosing errors were common in inpatient, outpatient and primary care settings. Omission of the administered dose as well as omission of prescribed medication at medication reconciliation were common. Studies of pharmacists’ interventions in clinical practice reported a varying level of acceptance, ranging from 53% to 98% of pharmacists’ recommendations. Conclusions Studies of medication errors, drug related problems and adverse drug events are increasing in the GCC. However, variation in methods, definitions and denominators preclude calculation of an overall error rate. Research with more robust methodologies and longer follow up periods is now required.Peer reviewe

Medication Reconciliation, Competency, Timely and Effective Care, and Hospital Readmissions

Hospital readmissions within 30 days of discharge result in significant multimillion-dollar penalties to thousands of Medicare-eligible hospitals throughout the United States and are indicators of suboptimal patient healthcare leading to less than ideal health outcomes for previously hospitalized patients. The purpose of this correlation study was to examine the relationship between medication reconciliation, nursing workforce competency, timely and effective care, and Medicare-eligible hospital 30-day readmission rates. The sample of 269 hospitals came from the population of Medicare-eligible hospitals throughout the United States. Complexity theory and the general model of readmission were theoretical frameworks grounding this study. Secondary data were from publicly available governmental databases. The reporting of the F statistic resulted in rejection of the null hypothesis in this study, based on evidence of the existence of a significant correlation between the variables. Findings shows a statistically significant relationship between nursing workforce competency, timely and effective care, and Medicare-eligible hospital 30-day readmission rates. Medication reconciliation, as measured in this study, was not a significant predictor of 30-day readmission rates. Implications of this study for positive social change include an understanding of factors related to hospital 30-day readmission rates to help leaders take action to enhance patient care, reduce inpatient care expenses, and decrease Medicare-imposed hospital penalties

Leveraging Health Information Technology to Reduce Hospital Readmissions Rates for Medicare Beneficiaries

In keeping with the aims of the Affordable Care Act to improve the efficiency of healthcare delivery, the Center for Medicare and Medicaid Services has instituted the Hospital Readmissions Reduction Program, which penalizes hospitals that report readmissions rates that exceed predetermined expectations. This paper outlines the causes of the readmissions dilemma and then considers the parameters of the HRRP as well as the major objections to its methodology, before moving to a discussion of intervention strategies hospitals can implement in order to achieve compliance. Health information technology tools and solutions play a significant role in helping to prevent undue rehospitalizations, and this paper concludes with an overview of several of the most prevalent means of leveraging electronic resources to curb readmissions.Master of Science in Information Scienc

The perceived benefits of healthcare information technology adoption: construct and survey development

This paper is a part of a large study, which examines healthcare professionals’ attitudes regarding the adoption, use and perceived benefits of healthcare information technology (HIT). To date, literature on HIT has shown many important benefits related to quality and efficiency as well as limitations related to generalization and to a lack of empirical data on benefits. The aim of this paper is to develop a survey instrument focused the perceived benefits of HIT adoption. We exhaustively reviewed the construct of perceived benefits in various research areas to identify established approaches to predicting individual’s intentions to adopt technology. The items of perceived benefits taken from previous studies were developed and modified, and three benefit dimensions (direct, indirect and strategic benefits) were described. The questionnaire addressed the following issues: demographic information, perceived benefits of computerized physician/provider order entry (CPOE), and intent to adopt CPOE. We present a survey instrument containing the perceived benefits construct targeting healthcare executives. This is developed and validated by the translational validity test that attempts to assess the degree to which we accurately translated our construct into the operationalization. The Importance of the instrument for perceived benefits of HIT adoption as well as its limitations is also presented

Patient Safety and Quality: An Evidence-Based Handbook for Nurses

Compiles peer-reviewed research and literature reviews on issues regarding patient safety and quality of care, ranging from evidence-based practice, patient-centered care, and nurses' working conditions to critical opportunities and tools for improvement

Effects of Health Information Technology Adoption on Nursing Home Quality Rating Scores in Minnesota Nursing Homes

Adoption of health information technology (HIT) may be instrumental in improving quality of care in Minnesota nursing homes. The purpose of this non-experimental, quantitative study was to examine the relationship between nursing homes’ quality of care, as measured by CMS Quality Rating Scores, and adoption of HIT systems in Minnesota nursing homes. Additionally, the purpose of the study was to examine the relationship between nursing homes’ quality of care, as measured by the Minnesota Department of Health (MDH) inspection rating score, and the adoption of HIT systems in Minnesota nursing homes. The research questions were aimed at understanding the effects of HIT adoption on CMS overall quality rating scores and MDH inspection rating scores. The study was conducted by examining the status of health information technology (HIT) in Minnesota nursing homes. Descriptive statistics of the 2011 Minnesota HIT e-health survey helped describe and summarize the data for further investigation. The relationships (correlation) of HIT adoption in nursing homes with CMS Quality Rating Scores were analyzed. Additionally, the relationships (correlation) of HIT adoption in nursing homes with Minnesota Department of Health (MDH) inspection results were analyzed. Pearson correlation coefficient equation and linear regression analysis were used to evaluate the hypotheses. The findings of this study revealed significant correlations with a small effect size for the HIT adoption of medication administration, medication reconciliation, computerized provider order entry (CPOE) laboratory test, computerized provider order entry (CPOE) medication, and CMS quality rating scores. Additionally, the findings of this study revealed a significant correlation with a small effect size for the HIT adoption of medication reconciliation and MDH inspection scores. The findings of this study did not show a relationship between the remaining HIT systems and CMS quality ratings or MDH inspection scores. These findings contribute to positive social change by assisting to inform stakeholders of nursing homes that HIT adoption may have some relationship to quality of care and services as indicated by the CMS rating system and MDH inspection ratings. Policy makers and legislators can use this information as a guide to decision making concerning HIT adoption in Minnesota nursing homes

Patient Engagement to Improve Medication Safety in the Hospital

Purpose: There is a pressing need to enhance patient safety in the hospital environment. While there are many initiatives that focus on improving patient safety, few have studied engaging patients themselves to participate in patient safety efforts. This work was motived by the belief that patients can contribute valuable information to their care and when equipped with the right tools, can play a role in improving medication safety in the hospital. Methods: This research had three aims and used a mixed-methods approach to better understand the concept of engaging patients to improve medication safety. In order to gain insight into whether patients could beneficially contribute to the safety of their hospital care, my first aim was to understand current perspectives on the sharing of clinical information with patients while they were in the hospital. To accomplish this aim, I conducted surveys with clinicians and enrolled patients in a short field study in which they received full access to their clinical chart. In Aim 2, I conducted a study to establish that the Patient Activation Measure (PAM), a common measure of patient engagement in the outpatient setting, showed reliability and validity in the inpatient setting. Building on the knowledge from Aim 1 and using the PAM instrument from Aim 2, my third aim evaluated the impact of providing patients with access to a medication review tool while they were preparing to be admitted to the hospital. Aim 3 was achieved through a randomized controlled trial (RCT) involving 65 patients I recruited from the emergency department at Columbia University Medical Center. I also conducted a survey of admitting clinicians who had patients participate in the trial to identify the impact on clinician practices and to elicit feedback on their perceptions of the intervention. Results: My research findings suggest that increased patient information sharing in the inpatient setting is beneficial and desirable to patients, and generally acceptable to clinicians. The clinician survey from Aim 1 showed that most respondents were comfortable with the idea of providing patients with their clinical information. Some expressed reservations that patients might misunderstand information and become unnecessarily alarmed or offended. In the patient field study from Aim 1, patients reported perceiving the information they received as highly useful, even if they did not fully understand complex medical terms. My primary contribution in Aim 2 was to provide sound evidence that the Patient Activation Measure is a valid and reliable tool for use in the inpatient setting. Establishing the validity and reliability of the PAM instrument in inpatient setting was essential for conducting the RCT in Aim 3, and it will provide a foundation for future clinicians and research investigators to measure and understand hospital patients’ levels of engagement. The results from the RCT in Aim 3 did not support my primary hypothesis that clinicians who had patients participate in their medication review process using an informatics tool would make more changes to the home medication list than clinicians who had patients in the control group. However, the results did suggest that most hospital patients are knowledgeable, willing, and able to contribute useful and important information to the medication reconciliation process. Interestingly, the clinicians I surveyed seemed far less convinced that their patients would be able to beneficially participate in the medication reconciliation process due to low health literacy and other barriers. Nevertheless, the clinicians did seem to believe that in theory, at least, patient involvement in the medication reconciliation process could have positive impacts on their workflow and potentially save them time. Conclusion: The overall theme resulting from my research is that patients can be a valuable resource to improve patient safety in the hospital. Patients are generally knowledgeable and willing to more actively participate in their hospital care. By developing the structures and processes to facilitate greater patient engagement, hospitals can provide an extra layer of safety and error prevention, particularly with respect to the medications patients take at home. As with any medical treatment, active participation in patient safety efforts may not be possible for all patients. However, I believe that if the culture of a hospital encourages openness and transparency, and if patients are given the proper tools and information, the quality and safety of hospital care will improve