Abstract 12518: The Association of Electronic Health Record Use With Acute MI Quality of Care and Outcomes: Results From the NCDR®
Introduction: In 2009, national legislation promoted wide adoption of the electronic health record (EHR) across US hospitals; however, the association of EHR use with acute MI quality of care is unknown.
Methods: Data regarding EHR use were collected from the American Hospital Association Annual Surveys (2007-2010), and data regarding acute MI processes of care and outcomes from the NCDR ACTION
Registry-GWTG. We compared patients treated at hospitals with self-reported fully-implemented EHR (n=43,527), partially-implemented EHR (n=72,029), and no EHR (n=9,270). Multivariable models were used to adjust for patient and hospital characteristics to determine associations between EHR implementation and process of care measures and in hospital outcomes.
Results: Overall EHR use increased from 183/223 hospitals (82.1%) in 2007 to 275/277 hospitals (99.3%) in 2010. Hospitals with fully-implemented (n=49) or partially-implemented (n=101) EHRs in 2008 did not differ in size, teaching status, for-profit status, or patient insurance status compared to hospitals without EHRs (n= 19) at that time. After adjustment, patients treated at hospitals with fully-implemented EHRs were significantly more likely to receive defect-free care. In NSTEMI, fully-implemented EHR use was associated with significantly lower risk of in-hospital mortality and major bleeding compared to no EHR use. In STEMI, risk of mortality and major bleeding did not significantly differ by EMR status (Figure).
Conclusion: EHR use has increased to very high levels among hospitals participating in ACTION Registry-GWTG. EHR use is associated with better adherence to guidelines-recommended therapies in acute MI and with an approximately 20% lower risk of in-hospital mortality or major bleeding in patients with NSTEMI; however, these differences were not seen among STEMI patients. Further studies are needed to elucidate the relationship between EHR use and acute MI quality of care and outcomes.
- Acute coronary syndromes
- Quality improvement
- Quality of medical care
- Health policy
- Myocardial infarction
- © 2013 by American Heart Association, Inc.