Medication administration quality and health information technology: a national study of US hospitals

Abstract

Objective: To determine whether the use of computerized physician order entry (CPOE) and electronic medication administration records (eMAR) is associated with better quality of medication administration at medium-to-large acute-care hospitals. DATA/STUDY SETTING: A retrospective cross-sectional analysis of data from three sources: CPOE/eMAR usage from HIMSS Analytics (2010), medication quality scores from CMS Hospital Compare (2010), and hospital characteristics from CMS Acute Inpatient Prospective Payment System (2009). The analysis focused on 11 quality indicators (January-December 2009) at 2603 medium-to-large (≥ 100 beds), non-federal acute-care hospitals measuring proportion of eligible patients given (or prescribed) recommended medications for conditions, including acute myocardial infarction, heart failure, and pneumonia, and surgical care improvement. Using technology adoption by 2008 as reference, hospitals were coded: (1) eMAR-only adopters (n=986); (2) CPOE-only adopters (n=115); and (3) adopters of both technologies (n=804); with non-adopters of both technologies as reference group (n=698). Hospitals were also coded for duration of use in 2-year increments since technology adoption. Hospital characteristics, historical measure-specific patient volume, and propensity scores for technology adoption were used to control for confounding factors. The analysis was performed using a generalized linear model (logit link and binomial family).

Principal findings: Relative to non-adopters of both eMAR and CPOE, the odds of adherence to all measures (except one) were higher by 14-29% for eMAR-only hospitals and by 13-38% for hospitals with both technologies, translating to a marginal increase of 0.4-2.0 percentage points. Further, each additional 2 years of technology use was associated with 6-15% higher odds of compliance on all medication measures for eMAR-only hospitals and users of both technologies.

Conclusions: Implementation and duration of use of health information technologies are associated with improved adherence to medication guidelines at US hospitals. The benefits are evident for adoption of eMAR systems alone and in combination with CPOE.

Figure 1

Adjusted ORs (95% CIs) for electronic medication administration records (eMAR) and computerized physician order entry (CPOE) adoption on medication process quality at medium-to-large acute-care hospitals in the USA (n=2603). AMI1: given aspirin at admission; AMI2: prescribed aspirin at discharge; AMI3: given angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) for left ventricular systolic dysfunction; AMI5: prescribed β blocker at discharge; HF3: given ACE inhibitor or ARB for left ventricular systolic dysfunction; PN5: given initial antibiotic(s) within 6 h of arrival; PN6: given most appropriate initial antibiotic(s); SCIPINF1: received preventive antibiotic within 1 h before incision; SCIPINF2: received most appropriate antibiotic(s) for surgery; SCIPINF3: stopped preventive antibiotic(s) within 24 h after surgery; SCIPVTE2: treatment to prevent blood clots within 24 h before or after surgery. The estimates reported are based on logistic regression operationalized through the generalized linear model with logit link. All regression models were adjusted for hospital characteristics including teaching status, profit status, membership in multihospital system, rural location, transfer-adjusted case mix index, qualified for disproportionate share payment, and natural log of licensed bed size and cumulative condition-specific patient volume during 2044–2008. All medication process quality measures were observed for the period January–December 2009, and eMAR and CPOE systems were reported to be in operational use by 2008. to control for endogeneity effects, in each regression, propensity score (of eMAR or CPOE adoption) based indicators corresponding to five quintiles of propensity score distribution were included. *Estimates significant at p<0.10.

Figure 2

Adjusted ORs (95% CIs) for duration of electronic medication administration records (eMAR) and computerized physician order entry (CPOE) use, measured in the increment of 2 years, on medication process quality at medium-to-large acute-care hospitals in the USA (n=2603). AMI1: given aspirin at admission; AMI2: prescribed aspirin at discharge; AMI3: given ACE inhibitor or ARB for left ventricular systolic dysfunction; AMI5: prescribed β blocker at discharge; HF3: given angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) for left ventricular systolic dysfunction; PN5: given initial antibiotic(s) within 6 h of arrival; PN6: given most appropriate initial antibiotic(s); SCIPINF1: received preventive antibiotic within 1 h before incision; SCIPINF2: received most appropriate antibiotic(s) for surgery; SCIPINF3: stopped preventive antibiotic(s) within 24 h after surgery; SCIPVTE2: treatment to prevent blood clots within 24 h before or after surgery. The estimates reported are based on logistic regression operationalized through the generalized linear model with logit link. All regression models were adjusted for hospital characteristics including teaching status, profit status, membership to multihospital system, rural location, transfer adjusted case mix index, qualified for disproportionate share payment, and natural log of licensed bed size and cumulative condition-specific patient volume during 2044–2008. All medication process quality measures were observed for the period January–December 2009, and eMAR and CPOE systems were reported to be in operational use by 2008. To control for endogeneity effects, in each regression, indicators based on the propensity score (of eMAR or CPOE adoption) corresponding to five quintiles of propensity score distribution were included.