The impact of electronic health records on healthcare quality: a systematic review and meta-analysis

Campanella, Paolo; Lovato, Emanuela; Marone, Claudio; Fallacara, Lucia; Mancuso, Agostino; Ricciardi, Walter; Specchia, Maria Lucia

doi:10.1093/eurpub/ckv122

Cited by 287 publications

(191 citation statements)

References 15 publications

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“…A study by Gommans et al in New Zealand has shown that rates of identification compliance among medical staff could be improved from 10% to 81% when the medication chart was changed to a single page requiring a single sticker and name . Several public and private hospitals within Queensland, Australia, have recently implemented the digitalisation of hospitals, which is regarded as a measure to improve medication safety . With digitalisation of prescribing, certain aspects of the NIMC audit tool, such as legibility and presence of patient ID stickers, will become redundant.…”

Section: Discussionmentioning

confidence: 99%

Comparison of emergency physiotherapy practitioner prescribers versus existing emergency department prescribers for musculoskeletal injuries

Gridley

Strudwick

Pink

et al. 2019

Emerg Medicine Australasia

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Objective: The scope of selected emergency physiotherapy practitioners (EPP) in this Australian nontertiary ED has recently extended to include the prescription of a limited drug formulary, including paracetamol, some NSAIDs and opioids, an anti-emetic, a benzodiazepine and nitrous oxide. Although there are large-scale studies investigating prescription errors made by doctors, there is a lack of data on prescribing practices of physiotherapists in the ED setting. The aim of present study is to compare the prescribing practices of EPP to their medical and nursing colleagues within the setting of treating musculoskeletal injuries in the ED. Methods: One hundred retrospective National Inpatient Medication Chart (NIMC) audits of adult patients presenting primarily with musculoskeletal complaints were undertaken using the standardised NIMC audit tool, with patient demographics, and NIMC audit results compared between groups. Results: Fifty medication charts were audited for each group, with a total of 212 drug orders. EPP demonstrated higher completion rates for patient identification, patient weight and medication history compared to medical and nursing staff. Legibility of drug names and route of administration appeared equivalent, whereas EPP had higher completion rates for legible drug doses and signatures compared to medical and nursing staff. Conclusion: In the management of ED patients with musculoskeletal complaints, prescription-trained EPP appear to perform similarly if not better than their medical and nursing colleagues with regards to NIMC audit tool results.

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Section: Discussionmentioning

confidence: 99%

Comparison of emergency physiotherapy practitioner prescribers versus existing emergency department prescribers for musculoskeletal injuries

Gridley

Strudwick

Pink

et al. 2019

Emerg Medicine Australasia

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show abstract

“…A recent systematic review and meta-analysis found that EHRs have a positive effect on quality of care. EHR use was associated with increased guideline adherence (RR 1.33, 95% CI 1.01-1.76), a lower number of medication errors (RR 0.46, 95% CI 0.38-0.55), and fewer adverse drug events (RR 0.66, 95% CI 0.44-0.99) [25]. Our current approach does not capture the clinical detail that contributes to a medical decision at the bedside.…”

Section: Discussionmentioning

confidence: 99%

Changes in Oral Anticoagulant Treatment Rates in Atrial Fibrillation before and after the Introduction of Direct Oral Anticoagulants

et al. 2016

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Background: Direct oral anticoagulants (DOACs) have the potential to improve stroke prevention among atrial fibrillation (AF) patients. We sought to determine if oral anticoagulation (OAC) treatment rates have increased since the approval of DOACs. Methods: We identified 6,688 patients with AF at an academic medical center from January 2008 to June 2015. We examined OAC prescription rates over time and according to CHA₂DS₂VASc score using multivariable Poisson regression models, with an interaction term between risk score and year of AF diagnosis. Results: Among 6,688 AF patients, 78% had CHA₂DS₂VASc scores ≥2, 51.6% of whom received an OAC prescription within 90 days of diagnosis. The OAC prescription rate was 47.8% in the pre-DOAC era and peaked at 56.4% in 2014. Relative to the pre-DOAC era, prescription rates increased in 2012 and leveled off thereafter. The prescription rate for the highest risk group was 58.5%, compared with 45.0% in patients with a CHA₂DS₂VASc score of 2 (p < 0.01). In the adjusted analysis, prescription rates were higher for the higher risk group (adjusted relative risk 1.24 for CHA₂DS₂VASc score 7-9 vs. 2, 95% CI 1.09-1.40). Conclusions: OAC treatment rates have increased since DOAC introduction, but substantial treatment gaps remain, specifically among the higher risk patients.

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“…Boland et al (2013) carried out a systematic review and meta-analysis to assess the cost-effectiveness of Chronic Obstructive Pulmonary Disease Disease Management (COPD-DM) programs in Netherlands, suggesting that COPD-DM programs have favorable effects on both health outcomes and costs, but there was considerable heterogeneity depending on patient, intervention, and study-characteristics. Campanella et al (2015) applied meta-analysis to assess the impact of electronic health record (EHR) on healthcare quality and the impact of Public Reporting on clinical outcomes (Campanella et al 2016). Gallet and Doucouliagos (2017) applied meta-regression analysis (MRA), and examine the healthcare spending elasticity for the mortality rate and the spending elasticity for life expectancy.…”

Section: Why Meta-analysis Is Used To Re-examine the Impact Of Healthmentioning

confidence: 99%

Impact of healthcare insurance on medical expense in China: new evidence from meta-analysis

et al. 2017

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This paper is aimed to make sense of the real effect of implement of social healthcare insurance on one's medical expense in China. Due to previous studies drew various and inconsistent conclusions on this issue, this works intend to apply meta-analysis to the problem. For 31 related studies, we first implement an advanced conditional Dirichlet-based Bayesian semi-parametric model specific to meta-analysis, and come to a primary conclusion that healthcare possesses little probability reducing one's medical expense in China. Further, the authors conduct random effects meta-regression and find that heterogeneity exists among the observed effect sizes. Mixed effects model shows that the age variation may is actually the heterogeneity source. The coefficients for Nonold and Old are respectively 0.29 and 0.54, implying that when researching on the medical expense for the elderly, it is more likely to conclude the medical insurance could increase medical spending. The coefficients for IV and OLS are both National Center for Mathematics and Interdisciplinary Sciences, CAS, Beijing, China remarkably negative at 90% confidence level. This suggests when directly using Instrument Variable (IV) approach and OLS method to assess the implementation effect for the healthcare insurance, it is inclined to result in the reduced impact on medical expense. We deduce this is because this two methods can't solve the sample-selection bias when compared with the Two-part model and difference-in-difference (DID) model. Based on the results and discussion, we finally propose suggests for the government.

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The impact of electronic health records on healthcare quality: a systematic review and meta-analysis

Abstract: EHR system, when properly implemented, can improve the quality of healthcare, increasing time efficiency and guideline adherence and reducing medication errors and ADEs. Strategies for EHR implementation should be therefore recommended and promoted.

Cited by 287 publications

References 15 publications

Comparison of emergency physiotherapy practitioner prescribers versus existing emergency department prescribers for musculoskeletal injuries

Comparison of emergency physiotherapy practitioner prescribers versus existing emergency department prescribers for musculoskeletal injuries

Changes in Oral Anticoagulant Treatment Rates in Atrial Fibrillation before and after the Introduction of Direct Oral Anticoagulants

Impact of healthcare insurance on medical expense in China: new evidence from meta-analysis

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