The Combined Effect of the Electronic Health Record and Hospitalist Care on Length of Stay

Overview

Journal Am J Manag Care

Specialty Health Services

Date 2015 May 28

PMID 26014309

Citations 1

Authors

Jinhyung Lee

Yong-Fang Kuo

Yu-Li Lin

James S Goodwin

Affiliations

Soon will be listed here.

Abstract

Objectives: To assess the combined impact of electronic health record (EHR) adoption and hospitalist care on length of stay (LOS).

Study Design: Retrospective cohort study using data from the Healthcare Information and Management Systems Society and a 5% national sample of Medicare beneficiaries. Patients included 20,862 admissions for respiratory disease cared for by hospitalists, and 28,714 admissions for respiratory disease cared for by nonhospitalists in 2985 general and surgical hospitals in the United States.

Methods: The interaction effect of EHR and hospitalist care on LOS was evaluated using generalized linear models with log-link normal distribution after controlling for patient and hospital characteristics.

Results: In multivariable analyses controlling for patient and hospital characteristics, we found that the reduced LOS associated with complete EHR was 0.166 days and was statistically significant in the hospitals in which 50% or less of patients were cared for by hospitalists. Moreover, we found that reductions in LOS associated with hospitalist care were greater in hospitals that had not adopted a complete EHR. LOS was 0.599 days shorter for patients cared for by hospitalists versus nonhospitalists in hospitals with incomplete EHR adoption; in hospitals with complete EHR adoption, the stay was 0.433 days shorter.

Conclusions: The reduced LOS associated with hospitalist care is greater than that associated with EHR adoption. However, the combined reduction in LOS with both EHR adoption and hospitalist care may be substantial.

Citing Articles

Value of Electronic Health Records Measured Using Financial and Clinical Outcomes: Quantitative Study.

Modi S, Feldman S, Berner E, Schooley B, Johnston A JMIR Med Inform. 2024; 12:e52524.

PMID: 38265848 PMC: 10851116. DOI: 10.2196/52524.

References

Kuo Y, Goodwin J . Effect of hospitalists on length of stay in the medicare population: variation according to hospital and patient characteristics. J Am Geriatr Soc. 2010; 58(9):1649-57. PMC: 2946246. DOI: 10.1111/j.1532-5415.2010.03007.x. View

PALMER H, Armistead N, Elnicki D, Halperin A, Ogershok P, Manivannan S . The effect of a hospitalist service with nurse discharge planner on patient care in an academic teaching hospital. Am J Med. 2002; 111(8):627-32. DOI: 10.1016/s0002-9343(01)00976-7. View

Lee J, Kuo Y, Goodwin J . The effect of electronic medical record adoption on outcomes in US hospitals. BMC Health Serv Res. 2013; 13:39. PMC: 3568047. DOI: 10.1186/1472-6963-13-39. View

Wachter R, Katz P, Showstack J, Bindman A, Goldman L . Reorganizing an academic medical service: impact on cost, quality, patient satisfaction, and education. JAMA. 1998; 279(19):1560-5. DOI: 10.1001/jama.279.19.1560. View

Coffman J, Rundall T . The impact of hospitalists on the cost and quality of inpatient care in the United States: a research synthesis. Med Care Res Rev. 2005; 62(4):379-406. DOI: 10.1177/1077558705277379. View

Wachter R . Reflections: the hospitalist movement a decade later. J Hosp Med. 2007; 1(4):248-52. DOI: 10.1002/jhm.105. View

Miller A, Tucker C . Can health care information technology save babies?. J Polit Econ. 2011; 119(2):289-324. DOI: 10.1086/660083. View

Borzekowski R . Measuring the cost impact of hospital information systems: 1987-1994. J Health Econ. 2009; 28(5):938-49. DOI: 10.1016/j.jhealeco.2009.06.004. View

Elixhauser A, Steiner C, Harris D, Coffey R . Comorbidity measures for use with administrative data. Med Care. 1998; 36(1):8-27. DOI: 10.1097/00005650-199801000-00004. View

10.

Furukawa M, Raghu T, Shao B . Electronic medical records, nurse staffing, and nurse-sensitive patient outcomes: evidence from California hospitals, 1998-2007. Health Serv Res. 2010; 45(4):941-62. PMC: 2910563. DOI: 10.1111/j.1475-6773.2010.01110.x. View

11.

McCullough J, Casey M, Moscovice I, Prasad S . The effect of health information technology on quality in U.S. hospitals. Health Aff (Millwood). 2010; 29(4):647-54. DOI: 10.1377/hlthaff.2010.0155. View

12.

Whelan C . The role of the hospitalist in quality improvement: systems for improving the care of patients with acute coronary syndrome. J Hosp Med. 2010; 5 Suppl 4:S1-7. DOI: 10.1002/jhm.828. View

13.

Rohde J, Jacobsen D, Rosenberg D . Role of the hospitalist in antimicrobial stewardship: a review of work completed and description of a multisite collaborative. Clin Ther. 2013; 35(6):751-7. DOI: 10.1016/j.clinthera.2013.05.005. View

14.

Patel V, Kushniruk A, Yang S, Yale J . Impact of a computer-based patient record system on data collection, knowledge organization, and reasoning. J Am Med Inform Assoc. 2000; 7(6):569-85. PMC: 129666. DOI: 10.1136/jamia.2000.0070569. View

15.

Love M, Mainous 3rd A, Talbert J, Hager G . Continuity of care and the physician-patient relationship: the importance of continuity for adult patients with asthma. J Fam Pract. 2000; 49(11):998-1004. View

16.

Teich J, Merchia P, Schmiz J, Kuperman G, Spurr C, Bates D . Effects of computerized physician order entry on prescribing practices. Arch Intern Med. 2000; 160(18):2741-7. DOI: 10.1001/archinte.160.18.2741. View

17.

Meltzer D, Manning W, Morrison J, Shah M, Jin L, Guth T . Effects of physician experience on costs and outcomes on an academic general medicine service: results of a trial of hospitalists. Ann Intern Med. 2002; 137(11):866-74. DOI: 10.7326/0003-4819-137-11-200212030-00007. View

18.

Freed D . Hospitalists: Evolution, evidence, and eventualities. Health Care Manag (Frederick). 2004; 23(3):238-56. DOI: 10.1097/00126450-200407000-00008. View

19.

Jha A, DesRoches C, Campbell E, Donelan K, Rao S, Ferris T . Use of electronic health records in U.S. hospitals. N Engl J Med. 2009; 360(16):1628-38. DOI: 10.1056/NEJMsa0900592. View

20.

Kearns P, Wang C, Morris W, LOW D, Deacon A, Chan S . Hospital care by hospital-based and clinic-based faculty: a prospective, controlled trial. Arch Intern Med. 2001; 161(2):235-41. DOI: 10.1001/archinte.161.2.235. View