Hospital Adoption of Electronic Decision Support Tools for Preeclampsia Management

Abstract

Background: Electronic health record (EHR)–based clinical decision support tools can improve the use of evidence-based clinical guidelines for preeclampsia management that can reduce maternal mortality and morbidity. No study has investigated the organizational capabilities that enable hospitals to use EHR-based decision support tools to manage preeclampsia. Objective: To examine the association of organizational capabilities and hospital adoption of EHR-based decision support tools for preeclampsia management. Methods: Cross-sectional analyses of hospitals providing obstetric care in 2017. In total, 739 hospitals responded to the 2017-2018 National Survey of Healthcare Organizations and Systems (NSHOS) and were linked to the 2017 American Hospital Association (AHA) Annual Survey Database and the Area Health Resources File (AHRF). A total of 425 hospitals providing obstetric care across 49 states were included in the analysis. The main outcome was whether a hospital adopted EHR-based clinical decision support tools for preeclampsia management. Hospital organizational capabilities assessed as predictors include EHR functions, adoption of evidence-based clinical treatments, use of quality improvement methods, and dissemination processes to share best patient care practices. Logistic regression estimated the association of hospital organizational capabilities and hospital adoption of EHR-based decision support tools to manage preeclampsia, controlling for hospital structural and patient sociodemographic characteristics. Results: Two-thirds of the hospitals (68%) adopted EHR-based decision support tools for preeclampsia, and slightly more than half (56%) of hospitals had a single EHR system. Multivariable regression results indicate that hospitals with a single EHR system were more likely to adopt EHR-based decision support tools for preeclampsia (17.4 percentage points; 95% CI, 1.9 to 33.0; P < .05) than hospitals with a mixture of EHR and paper-based systems. Compared with hospitals having multiple EHRs, on average, hospitals having a single EHR were also more likely to adopt the tools by 9.3 percentage points, but the difference was not statistically significant (95% CI, −1.3 to 19.9). Hospitals with more processes to aid dissemination of best patient care practices were also more likely to adopt EHR-based decision-support tools for preeclampsia (0.4 percentage points; 95% CI, 0.1 to 0.6, for every 1-unit increase in dissemination processes; P < .01). Conclusion: Standardized EHRs and policies to disseminate evidence are foundational hospital capabilities that can help advance the use of EHR-based decision support tools for preeclampsia management in the approximately one-third of US hospitals that still do not use them.

Hospital Capabilities Associated With Behavioral Health Integration Within Emergency Departments

“…[11][12][13] Second, we examined whether hospital processes to disseminate best practices were associated with the use of BH care processes, as prior evidence observed that hospitals with processes to disseminate best-care practices were more likely to use clinical decision support tools to enhance care in other clinical domains. 14 Third, based on evidence on the importance of innovation capacity in relation to other upstream care strategies, 15 we examined whether barriers to innovation may impede the implementation of new processes like BH care in the ED. Last, we examined the hospital capacity to treat BH conditions based on the presence of designated beds for psychiatric or substance use disorders.…”

“…First, because recent studies have found that hospitals using quality improvement methods were more likely to adopt care delivery innovations, we examined associations between BH care processes and hospital use of Lean, Six Sigma, or Robust Performance Improvement 11–13 . Second, we examined whether hospital processes to disseminate best practices were associated with the use of BH care processes, as prior evidence observed that hospitals with processes to disseminate best-care practices were more likely to use clinical decision support tools to enhance care in other clinical domains 14 . Third, based on evidence on the importance of innovation capacity in relation to other upstream care strategies, 15 we examined whether barriers to innovation may impede the implementation of new processes like BH care in the ED.…”