Computerized Provider Order Entry and Health Care Quality on Hospital Level among Pediatric Patients during 2006-2009

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Autor/in	Wang, Liya
Titel	Computerized Provider Order Entry and Health Care Quality on Hospital Level among Pediatric Patients during 2006-2009
Quelle	(2016), (154 Seiten) PDF als Volltext Verfügbarkeit Ph.D. Dissertation, Tulane University, School of Public Health and Tropical Medicine
Sprache	englisch
Dokumenttyp	gedruckt; online; Monographie
ISBN	978-0-3551-6542-5
Schlagwörter	Hochschulschrift; Dissertation; Electronic Publishing; Records (Forms); Physicians; Health Services; Pediatrics; Hospitals; Correlation; Classification; Hospitalized Children; Neonates; Infant Mortality; Organization Size (Groups) + Suchen Sie Ihr Suchwort? Thesis; Dissertations; Academic thesis; Elektronisches Publizieren; Formularsammlung; Physician; Doctor; Arzt; Health service; Gesundheitsdienst; Gesundheitswesen; Klinische Sozialpädiatrie; Krankengymnast; Krankenhaus; Korrelation; Classification system; Klassifikation; Klassifikationssystem; Neugeborenes Kind; Kindersterblichkeit; Organization size; Unternehmensgröße
Abstract	This study examined the association between Computerized Physician Order Entry (CPOE) application and healthcare quality in pediatric patients at hospital level. This was a retrospective study among 1,428 hospitals with pediatric setting in Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Database (KID) and Health Information and Management System Society (HIMSS) database. The primary independent variable was the CPOE status in 2008 and no hospitals in this study had CPOE in 2005. The primary dependent variables are thirteen Pediatric Quality Indicators (PQI) in 2006 and 2009. Difference in Difference binary logit model was used to evaluate the association between CPOE application and PQI. Among these 1,428 hospitals, there was no CPOE alive or operational in 2005 and around 25% (n=263) had CPOE alive or operational in 2008. According to the logistic regression models in difference-in-difference setting, there was no significant association between CPOE in 2008 and improvements in pediatric quality indicators (all p-values>=0.05). Hospitals were stratified according to bed size, ownership, teaching status, location (rural/urban) and whether admissions were primarily to children's hospitals. In hospitals with a bed size of 200-299, neonatal mortality in 2008 was significantly improved after CPOE was implemented (p=0.017). Specially, 45% hospitals without CPOE and 55% hospitals with CPOE had this event in year 2006; but in year 2009 it was 55% hospitals without CPOE versus 48% hospitals with CPOE. Postoperative hemorrhage or hematoma was also significantly improved after CPOE implement for non-federal government hospitals (p=0.024). In year 2006, 1% hospitals without CPOE and 19% hospitals with CPOE had this event; but in year 2009 it was 5% for hospitals without CPOE and 8% for hospitals with CPOE. However, iatrogenic pneumothorax in neonates got significantly worse after CPOE implementation in 2008 among non-teaching hospitals (p=0.036). In year 2006, 1% hospitals without CPOE and 1% hospitals with CPOE; but in year 2009 it was 0% for hospitals without CPOE and 2% for hospitals with CPOE. According to analysis on duration of CPOE implement, the iatrogenic pneumothorax neonate got significantly worse for hospitals which just implemented CPOE in 2008 and the birth trauma-injury to neonate got significantly worse for hospitals which implemented CPOE in 2006. Overall CPOE was not significantly associated with improvements in thirteen PQIs on hospital level. However, CPOE implementation was significantly associated with improvement in neonatal mortality for hospitals with bed size of 200-299 and with improvement in postoperative hemorrhage or hematoma for hospitals owned by non-federal government; meanwhile significantly associated with worsened iatrogenic pneumothorax neonate index for non-teaching hospitals. Worse iatrogenic pneumothorax neonate and birth trauma-injury to neonate got significantly worse for hospitals which just implemented CPOE in 2008, and in 2006, respectively. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.] (As Provided).
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Erfasst von	ERIC (Education Resources Information Center), Washington, DC
Update	2020/1/01