Appendix Tables 5a–e.
Appendix Table 5a: Baseline Hospital Characteristics by Quality Category | |||||
---|---|---|---|---|---|
Characteristic | High Quality (N = 508) | Intermediate Quality (N = 670) | Low Quality (N = 459) | p-value | |
Percent | |||||
Size | Small (6–99 beds) | 12.8 | 14.8 | 20.7 | <0.001 |
Medium (100–399 beds) | 65.9 | 65.5 | 69.1 | ||
Large (≥ 400 beds) | 21.3 | 19.6 | 10.2 | ||
Region | Northeast | 20.2 | 20.2 | 15.8 | <0.001 |
Midwest | 36.9 | 23.3 | 12.6 | ||
South | 30.3 | 36.0 | 49.0 | ||
West | 12.5 | 20.5 | 22.7 | ||
Ownership | Private for-profit | 9.2 | 15.8 | 23.1 | <0.001 |
Private non-profit | 82.0 | 69.9 | 56.4 | ||
Public | 8.8 | 14.3 | 20.5 | ||
Teaching hospital | 42.7 | 41.3 | 29.5 | <0.001 | |
Member of hospital system | 69.0 | 61.9 | 55.8 | <0.001 | |
Urban Location | 82.5 | 80.5 | 68.5 | <0.001 | |
Dedicated coronary care unit | 56.0 | 51.1 | 35.8 | <0.001 | |
Percentage of Medicaid Patients | 10.0 | 11.8 | 13.3 | <0.001* |
Appendix Table 5b: Proportion of hospitals with selected electronic functionalities implemented in at least one unit in the high, intermediate, and low quality grades | |||||
---|---|---|---|---|---|
EHR Function | High Quality (N = 508) | Intermediate Quality (N = 670) | Low Quality (N = 459) | Difference (high – low) | p-value |
Percent | |||||
Clinical Documentation | |||||
Patient demographics | 94.4 | 95.0 | 92.1 | 2.3 | 0.14 |
Physician notes | 40.4 | 38.3 | 37.9 | 2.5 | 0.69 |
Nurses notes | 75.3 | 74.3 | 68.7 | 6.5 | 0.05 |
Problem lists | 55.1 | 57.2 | 51.7 | 3.5 | 0.2 |
Medication lists | 83.7 | 78.4 | 75.2 | 8.5 | 0.01 |
Discharge Summaries | 77.1 | 74.6 | 73.6 | 3.5 | 0.44 |
Advanced directives | 63.4 | 59.0 | 54.9 | 8.4 | 0.036 |
Results Viewing | |||||
Lab Reports | 96.0 | 96.3 | 96.1 | −0.1 | 0.97 |
Radiology Reports | 96.6 | 96.1 | 95.7 | 0.9 | 0.80 |
Radiology Images | 96.1 | 96.4 | 89.0 | 7.1 | <.0001 |
Diagnostic Test Results | 86.3 | 82.6 | 76.9 | 9.4 | 0.001 |
Diagnostic Test Images | 73.8 | 69.4 | 58.7 | 15.1 | <.0001 |
Consultant Reports | 79.1 | 78.9 | 73.2 | 5.9 | 0.05 |
Computerized Order Entry | |||||
Laboratory Tests | 41.9 | 39.7 | 35.3 | 6.7 | 0.11 |
Radiology Tests | 41.9 | 39.5 | 34.3 | 7.6 | 0.05 |
Medications | 38.0 | 37.0 | 30.5 | 7.5 | 0.03 |
Consultation Requests | 34.0 | 33.8 | 28.7 | 5.3 | 0.13 |
Nursing Orders | 44.4 | 41.8 | 35.3 | 9.1 | 0.01 |
Decision Support | |||||
Clinical Guidelines | 44.3 | 43.1 | 32.2 | 12.1 | <.001 |
Clinical Reminders | 52.6 | 50.0 | 37.8 | 14.7 | <.0001 |
Drug Allergy Alerts | 36.5 | 35.0 | 27.6 | 8.9 | <.001 |
Drug-Drug Interaction Alerts | 35.7 | 33.9 | 26.4 | 9.3 | <.001 |
Drug-Lab Interaction Alerts | 29.1 | 28.8 | 21.1 | 8.1 | <.001 |
Drug Dosing Support | 30.2 | 28.8 | 20.8 | 9.3 | <.001 |
Appendix Table 5c: Adjusted Proportions and Differences of Proportions of Hospitals with Selected Electronic Functionalities Implemented in At Least One Unit in the Highest, Intermediate, and Lowest Quality Groups | |||||
---|---|---|---|---|---|
Quality Group: | High Quality | Intermediate Quality | Low Quality | Difference (High-low) | P value |
Percent | |||||
Clinical Documentation | |||||
Patient Demographics | 94.8 | 95.8 | 94.2 | 0.6 | 0.27 |
Physician Notes | 40.6 | 38.0 | 38.2 | 2.4 | 0.56 |
Nurses Notes | 75.7 | 74.5 | 69.8 | 5.9 | 0.04 |
Problem Lists | 56.2 | 57.4 | 52.0 | 4.2 | 0.11 |
Medication Lists | 83.8 | 78.5 | 77.0 | 6.7 | <0.01 |
Discharge Summaries | 77.1 | 74.6 | 74.8 | 2.3 | 0.47 |
Advanced Directives | 63.6 | 59.3 | 57.2 | 6.4 | 0.07 |
Results Viewing | |||||
Lab Reports | 96.9 | 97.1 | 97.5 | −0.6 | 0.74 |
Radiology Reports | 97.3 | 97.0 | 97.2 | 0.1 | 0.884 |
Radiology Images | 96.5 | 96.7 | 90.6 | 5.9 | <0.001 |
Diagnostic Test Results | 86.9 | 83.5 | 81.4 | 5.6 | 0.02 |
Diagnostic Test Images | 74.4 | 69.8 | 62.3 | 12.1 | <0.001 |
Consultant Reports | 78.7 | 78.8 | 75.2 | 3.5 | 0.20 |
CPOE | |||||
Laboratory Tests | 40.9 | 39.5 | 38.2 | 2.8 | 0.63 |
Radiology Tests | 41.0 | 39.3 | 37.0 | 3.9 | 0.39 |
Medications | 36.9 | 36.6 | 33.0 | 3.8 | 0.30 |
Consultation Requests | 31.9 | 33.1 | 31.7 | 0.2 | 0.83 |
Nursing orders | 43.4 | 41.8 | 38.4 | 4.9 | 0.22 |
Decision Support | |||||
Clinical Guidelines | 43.3 | 42.4 | 34.3 | 9.0 | <0.01 |
Clinical Reminders | 51.5 | 49.9 | 40.7 | 10.8 | <0.001 |
Drug Allergy Alerts | 35.1 | 34.5 | 30.2 | 4.9 | 0.16 |
Drug-Drug Interaction Alerts | 34.1 | 33.3 | 28.9 | 5.2 | 0.12 |
Drug-Lab Interaction Alert | 28.1 | 28.3 | 22.9 | 5.2 | 0.05 |
Drug Dosing Support | 28.5 | 27.9 | 22.5 | 6.0 | 0.03 |
Appendix Table 5d: Adjusted Proportions and Differences in Proportions of Non-Adopting Hospitals with No Resources or No Plans to Implement Selected Electronic Functionalities in the Highest, Intermediate, and Lowest Quality Groups | |||||
---|---|---|---|---|---|
Quality Group: | High Quality | Intermediate Quality | Low Quality | Difference (low-high) | P value |
Percent | |||||
Clinical Documentation | |||||
Patient Demographics | 49.7 | 50.6 | 49.4 | −0.3 | 0.99 |
Physician Notes | 50.6 | 57.3 | 54.7 | 4.1 | 0.13 |
Nurses Notes | 35.2 | 43.4 | 47.7 | 12.5 | 0.07 |
Problem Lists | 44.0 | 50.0 | 52.2 | 8.2 | 0.14 |
Medication Lists | 32.4 | 32.1 | 40.2 | 7.9 | 0.27 |
Discharge Summaries | 52.2 | 44.0 | 45.4 | −6.8 | 0.28 |
Advanced Directives | 56.5 | 63.0 | 65.4 | 8.9 | 0.13 |
Results Viewing | |||||
Lab Reports | 49.5 | 46.3 | 72.4 | 22.9 | 0.23 |
Radiology Reports | 58.3 | 48.5 | 62.4 | 4.1 | 0.68 |
Radiology Images | 44.1 | 27.8 | 37.6 | −6.5 | 0.45 |
Diagnostic Test Results | 59.9 | 45.8 | 51.3 | −8.6 | 0.12 |
Diagnostic Test Images | 55.9 | 51.0 | 57.6 | 1.7 | 0.29 |
Consultant Reports | 50.6 | 53.1 | 63.2 | 12.6 | 0.07 |
CPOE | |||||
Laboratory Tests | 52.4 | 59.2 | 59.5 | 7.1 | 0.08 |
Radiology Tests | 51.8 | 58.6 | 60.1 | 8.3 | 0.05 |
Medications | 50.6 | 58.0 | 59.6 | 9.0 | 0.03 |
Consultation Requests | 52.9 | 59.7 | 61.3 | 8.3 | 0.03 |
Nursing orders | 49.6 | 58.6 | 60.9 | 11.3 | <0.01 |
Decision Support | |||||
Clinical Guidelines | 52.9 | 52.7 | 60.1 | 7.1 | 0.06 |
Clinical Reminders | 53.3 | 51.4 | 56.9 | 3.5 | 0.29 |
Drug Allergy Alerts | 17.1 | 23.5 | 22.8 | 5.8 | 0.07 |
Drug-Drug Interaction Alerts | 40.2 | 45.7 | 50.3 | 10.0 | 0.21 |
Drug-Lab Interaction Alerts | 48.4 | 50.4 | 53.4 | 5.0 | 0.53 |
Drug Dosing Support | 44.5 | 52.6 | 52.6 | 8.1 | 0.10 |
Appendix Table 5e: Proportion of Selected “Meaningful Use” Criteria in the High, Intermediate, and Low Quality Groups | |||||
---|---|---|---|---|---|
Meaningful Use Objectives | High Quality (N = 508) | Intermediate Quality (N = 670) | Low Quality (N = 459) | Difference (high - low) | p-value |
Percent | |||||
Core Measures | |||||
Computerized Order Entry | 37.7 | 36.7 | 30.5 | 7.2 | 0.04 |
Implement Drug-Drug, Drug-Allergy Checks | 20.1 | 17.8 | 13.8 | 6.3 | 0.04 |
Maintain Up-to-date Problem Lists | 54.8 | 55.6 | 50.4 | 4.4 | 0.21 |
Maintain Active Medication Lists | 82.5 | 78.2 | 74.7 | 7.8 | 0.02 |
Record Key Demographics | 94.1 | 94.9 | 91.7 | 2.4 | 0.10 |
Give Patients an Electronic Copy of Discharge Summaries | 76.7 | 74.0 | 72.6 | 4.1 | 0.35 |
Report Hospital Quality Measures to State or CMS | 32.3 | 31.5 | 31.1 | 1.2 | 0.92 |
Implement at Least One of Four Clinical Decision Rules | 76.4 | 71.9 | 68.3 | 8.1 | 0.02 |
Have Capability to Exchange Key Clinical Information | 57.4 | 55.1 | 47.1 | 10.3 | 0.0040 |
All nine core criteria | 3.3 | 4.0 | 1.7 | 1.6 | 0.0552 |
Menu Measures | |||||
Incorporate Clinical Lab-Test Results Into EHR As Structured Data | 95.0 | 95.4 | 95.7 | −0.6 | 0.90 |
Perform Medication Reconciliation | 65.4 | 64.6 | 58.6 | 6.8 | 0.06 |
Record Advanced Directives | 62.2 | 58.3 | 54.0 | 8.4 | 0.04 |
All 3 menu criteria | 45.7 | 42.5 | 37.7 | 8.0 | 0.04 |
All 9 core and all 3 menu criteria | 2.7 | 3.0 | 1.3 | 1.5 | 0.12 |
P-value for differences in mean percentage of Medicaid patients determined by ANOVA
CPOE=computerized physician order entry.