Dissertation/Thesis Abstract

Effects of Meaningful Use Requirements: Performance Assessment of Acute Care Hospitals Based on the Clinical Outcomes of Care
by Sharma, Devika, D.H.A., Central Michigan University, 2018, 111; 10743509
Abstract (Summary)

The medical literature is replete with studies on the issues of quality of care and patient safety. Several initiatives have been undertaken nationally to improve the quality of care and reduce the incidence of in-hospital adverse events. The report Crossing the Quality Chasm: Building a Healthcare System for the 21st Century, posited to transform the healthcare system and improve the quality of care required a paradigm shift from a paternalistic to a patient-centric healthcare delivery model. It was further reiterated in the report that safety is a systems property and patients should be safe from harms and injuries caused by the system. The report envisioned a retooled, realigned and a coordinated health care delivery system where health information technology (HIT) would provide new and improved channels for information flow and communication between all stakeholders involved in healthcare delivery. To accelerate the adoption of health information technology, the American Recovery and Reinvestment Act (ARRA) of 2009 included a Health Information Technology for Economic and Clinical Health (HITECH) component and $27 billion in incentives for eligible providers and eligible hospitals through the Centers for Medicare and Medicaid Services (CMS). Beginning in 2011, the CMS has paid a total of $35,663,068,148 in incentives to eligible providers and hospitals. Hence, it is essential to evaluate whether this investment in incentives for meeting the requirements for meaningful use has translated into improved outcomes of care in acute care hospitals, which have met the requirements for meaningful use of electronic health record (EHRs). The purpose of this study is to determine the effects of meeting the requirements for meaningful use on clinical outcomes of care in acute care hospitals and to examine if there is a statistically significant difference in the clinical outcomes of care between acute care hospitals, which have met the requirements for meaningful use (MU) and acute care hospitals, which have not met the requirements for meaningful use.

A cross-sectional descriptive study was conducted to determine the effects of meeting the requirements for meaningful use on the quality and safety of patient care delivered in acute care hospitals in the all fifty states and the District of Columbia. The data, for the study, was obtained from 2014–2015 CMS Hospital Compare database, CMS EHR Incentive Program, CMS Inpatient Prospective Payment System (IPPS) database, and American Hospital Association (AHA) database. The unit of analysis for the study was acute care hospital.

Principal Findings: There is a positive association between acute care hospital meeting the requirements for meaningful use and its clinical outcome measures for common conditions (AMI, CHF, &PN) as measured by 30-day readmission and 30-day mortality rates, when controlling for organizational characteristics (size, type, teaching status, and location) and case mix index (CMI). There is also a positive association between an acute care hospital meeting the requirements for MU and patient safety as measured by PSI-90 and hospital-acquired infections (HAI). Two one-way ANOVA test was conducted to measure the difference between groups. The results of the one-way ANOVA did not reveal a main effect of meeting the requirements for meaningful use on quality of care between hospitals, which have met the requirements for meaningful use and acute care hospitals which have not met the requirements for meaningful use. The main effect, MUSTAGE was not significant at the 95% confidence level, F(2, 1647) = 0.94, p = .389, indicating there were no significant differences in Quality by MUSTAGE levels. However, the results of one-way ANOVA for safety were significant, F(2, 2019) = 5.24, p = .005, indicating there were significant differences in patient safety among the levels of MUSTAGE. The eta squared was 0.01 indicating MUSTAGE explains approximately 1% of the variance in patient safety between acute care hospital which has met the requirements for meaningful use, and acute care hospital that has not met the requirements for meaningful use. Conclusions: The HITECH Act and the incentives included for meeting the requirements for meaningful use has promoted increased adoption of advanced capabilities of EHRs to meet the requirements for MU2 as the majority of the hospitals in the United States had met the requirements for MU2 in 2016. This increase in the adoption and use of EHRs had a positive effect on quality of care and patient safety. The increase in the adoption and use of EHRs has also led to the increased creation of structured and standardized medical records which will be easier to exchange with providers involved in care. (Abstract shortened by ProQuest.)

Indexing (document details)
Advisor: Berkshire, Steven David
Commitee: Fulton, Lawrence V., Taylor, Beth A.
School: Central Michigan University
Department: Health Administration
School Location: United States -- Michigan
Source: DAI-B 79/07(E), Dissertation Abstracts International
Source Type: DISSERTATION
Subjects: Health care management
Keywords: EMR, Patient safety, Quality
Publication Number: 10743509
ISBN: 9780355616033
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