A Pilot Health Information Technology–Based Effort to Increase the Quality of Transitions From Skilled Nursing Facility to Home: Compelling Evidence of High Rate of Adverse Outcomes

Purpose To document and compare the outcomes from monthly drug regimen review recommendation acceptance and rejection in one skilled nursing facility by one consultant pharmacist (CP) in the fourth year of evaluation with the prior 3 years' data. Method A non-randomized, observational, prospective cohort study with all patients being residents for at least 30 days over the 12-month period (October 1, 1997 to September 30, 1998) in a skilled nursing facility with more than 100 beds. The admission problem-oriented records of all patients and their respective CP reports were screened for pharmacotherapy recommendations and subsequent acceptance and rejection on a monthly, repeated-measures basis for 12 months. There were 2,004 monthly drug regimen review (DRR) reports. The percentage of DRR reports that made recommendations was tabulated. Written recommendations made to attending physicians that were either accepted or rejected within 3 months were analyzed. The charges for adverse outcomes were calculated from billing records or prior studies of the outcome. These results were compared with prior 1- and 2-year studies of outcomes within the same setting. Carryover effects of recommendations implemented in prior periods were also calculated. Results There were 178 recommendations made in 2,004 DRR reports (8.9%). A low acceptance rate, 27 of 178 recommendations (15.2%), resulted and was combined with carryover of prior acceptance in a cost savings of $113,962. The 151 recommendations that were rejected resulted in $226,503 of presumed unnecessary costs to the health care system. A prior 2-year study of recommendations with an acceptance rate of 89% showed costs savings of $111,609 per year with acceptance and $112,297 added costs per year with 11% rejection. The first-year study had a 93% acceptance rate at a projected cost savings of $43,854 and costs increased by $60,825 with a 7% rejection. The costs of recommendation rejection in the fourth year were substantially higher, with a higher rejection rate than was seen in the prior 3 years of observation. Conclusion Documentation of the costs from CP intervention should factor in costs of rejection that may increase with the percentage rejection of recommendations, length of observation period, and may vary between facilities.

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The evolution of quality improvement in healthcare: Patient-centered care and health information technology applications

Journal of Hospital Administration ◽

10.5430/jha.v5n2p62 ◽

2016 ◽

Vol 5 (2) ◽

pp. 62 ◽

Cited By ~ 4

Author(s):

John Cantiello ◽

Panagiota Kitsantas ◽

Shirley Moncada ◽

Sabiheen Abdul

Keyword(s):

Information Technology ◽

Quality Improvement ◽

Health Information Technology ◽

Health Information ◽

Patient Centered Care ◽

Healthcare Industry ◽

Patient Centered ◽

Technology Applications ◽

Centered Care

Objective: Quality improvement in the healthcare industry has evolved over the past few decades. In recent years, an increased focus on coordination of care efforts and the introduction of health information technology has been of high importance in improving the quality of patient care.Methods: In this review, we present a history of quality improvement efforts, discuss quality improvement in the healthcare industry, and examine quality improvement strategies with a focus on patient-centered care and information technology applications via patient registries.Results: Evidence shows that the key to quality improvement efforts in the healthcare industry is the coordination of patient care efforts through better data evaluation processes. By utilizing patient registries that can be linked to electronic health records (EHRs) and the Patient-Centered Medical Home (PCMH) framework, the quality of care provided to patients can be improved.Conclusions: While many healthcare organizations have quality improvement departments or teams in place that may be able to handle these types of efforts, it is important for organizations to be familiar with processes and frameworks that employees at different levels of the organization can be involved in. In order to ensure successful outcomes from quality improvement initiatives, managers and clinicians should work together in identifying problems and developing solutions.

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A Survey of the Literature on Unintended Consequences Associated with Health Information Technology: 2014–2015

Yearbook of Medical Informatics ◽

10.15265/iy-2016-036 ◽

2016 ◽

Vol 25 (01) ◽

pp. 13-29 ◽

Cited By ~ 13

Author(s):

J. Abraham ◽

L. L. Novak ◽

T. L. Reynolds ◽

A. Gettinger ◽

K. Zheng

Keyword(s):

Information Technology ◽

Time Series ◽

Health Information Technology ◽

Health Information ◽

Unintended Consequences ◽

Adverse Outcomes ◽

Future Research ◽

Health It ◽

Recorded Data ◽

The Impact

SummaryObjective: To summarize recent research on unintended consequences associated with implementation and use of health information technology (health IT). Included in the review are original empirical investigations published in English between 2014 and 2015 that reported unintended effects introduced by adoption of digital interventions. Our analysis focuses on the trends of this steam of research, areas in which unintended consequences have continued to be reported, and common themes that emerge from the findings of these studies.Method: Most of the papers reviewed were retrieved by searching three literature databases: MEDLINE, Embase, and CINAHL. Two rounds of searches were performed: the first round used more restrictive search terms specific to unintended consequences; the second round lifted the restrictions to include more generic health IT evaluation studies. Each paper was independently screened by at least two authors; differences were resolved through consensus development.Results: The literature search identified 1,538 papers that were potentially relevant; 34 were deemed meeting our inclusion criteria after screening. Studies described in these 34 papers took place in a wide variety of care areas from emergency departments to ophthalmology clinics. Some papers reflected several previously unreported unintended consequences, such as staff attrition and patients’ withholding of information due to privacy and security concerns. A majority of these studies (71%) were quantitative investigations based on analysis of objectively recorded data. Several of them employed longitudinal or time series designs to distinguish between unintended consequences that had only transient impact, versus those that had persisting impact. Most of these unintended consequences resulted in adverse outcomes, even though instances of beneficial impact were also noted. While care areas covered were heterogeneous, over half of the studies were conducted at academic medical centers or teaching hospitals. Conclusion: Recent studies published in the past two years represent significant advancement of unintended consequences research by seeking to include more types of health IT applications and to quantify the impact using objectively recorded data and longitudinal or time series designs. However, more mixed-methods studies are needed to develop deeper insights into the observed unintended adverse outcomes, including their root causes and remedies. We also encourage future research to go beyond the paradigm of simply describing unintended consequences, and to develop and test solutions that can prevent or minimize their impact.

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INTEREST GROUP SESSION - RESEARCH ON QUALITY OF CARE: SKILLED NURSING FACILITY QUALITY REPORTING PROGRAM: AN OVERVIEW OF THE PROGRAM AND NATIONAL PERFORMANCE

Innovation in Aging ◽

10.1093/geroni/igy023.097 ◽

2018 ◽

Vol 2 (suppl_1) ◽

pp. 26-26

Author(s):

L Smith ◽

Q Li ◽

T McMullen

Keyword(s):

Quality Of Care ◽

Interest Group ◽

Skilled Nursing Facility ◽

Group Session ◽

Nursing Facility ◽

Skilled Nursing ◽

Quality Reporting ◽

National Performance

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HRSA-ONC Beacon Program to Improve Quality of Health Care for Community Health Centers Through the Use of Health Information Technology

CIN Computers Informatics Nursing ◽

10.1097/01.ncn.0000453181.64724.fe ◽

2014 ◽

Vol 32 (8) ◽

pp. 363-364

Author(s):

Anna Poker ◽

Suma Nair ◽

Edwin Lomotan

Keyword(s):

Health Care ◽

Information Technology ◽

Community Health ◽

Health Information Technology ◽

Health Information ◽

Quality Of Health Care ◽

Community Health Centers ◽

Health Centers ◽

Improve Quality

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Effects of health information technology on patient outcomes: a systematic review

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocv138 ◽

2015 ◽

Vol 23 (5) ◽

pp. 1016-1036 ◽

Cited By ~ 45

Author(s):

Samantha K Brenner ◽

Rainu Kaushal ◽

Zachary Grinspan ◽

Christine Joyce ◽

Inho Kim ◽

...

Keyword(s):

Information Technology ◽

Patient Safety ◽

Health Information Technology ◽

Health Information ◽

Clinical Decision ◽

Cochrane Library ◽

Health It ◽

Term Care ◽

Safety Outcomes

Abstract Objective To systematically review studies assessing the effects of health information technology (health IT) on patient safety outcomes. Materials and Methods The authors employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement methods. MEDLINE, Cumulative Index to Nursing Allied Health (CINAHL), EMBASE, and Cochrane Library databases, from 2001 to June 2012, were searched. Descriptive and comparative studies were included that involved use of health IT in a clinical setting and measured effects on patient safety outcomes. Results Data on setting, subjects, information technology implemented, and type of patient safety outcomes were all abstracted. The quality of the studies was evaluated by 2 independent reviewers (scored from 0 to 10). A total of 69 studies met inclusion criteria. Quality scores ranged from 1 to 9. There were 25 (36%) studies that found benefit of health IT on direct patient safety outcomes for the primary outcome measured, 43 (62%) studies that either had non-significant or mixed findings, and 1 (1%) study for which health IT had a detrimental effect. Neither the quality of the studies nor the rate of randomized control trials performed changed over time. Most studies that demonstrated a positive benefit of health IT on direct patient safety outcomes were inpatient, single-center, and either cohort or observational trials studying clinical decision support or computerized provider order entry. Discussion and Conclusion Many areas of health IT application remain understudied and the majority of studies have non-significant or mixed findings. Our study suggests that larger, higher quality studies need to be conducted, particularly in the long-term care and ambulatory care settings.

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