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Please forward this error screen to 209. Advanced EHR adoption was independently associated with fewer patients with prolonged length of stay and seven-day readmissions. This innovative study demonstrated that advanced stages of EHR adoption show some promise in improving important patient outcomes of prolonged length of stay and hospital readmissions. Strongly evident by the relationships among better nursing work environments, better quality nursing care, and patient satisfaction is the importance of supporting the fundamentals of quality nursing care as technology is integrated into practice. Introduction The promise of advanced technology to transform healthcare is underway. We are in an exciting and dynamic period of discovery, and importantly generating knowledge that informs and impacts healthcare organizations, healthcare workers and ultimately patient outcomes. Our innovative study adds to this body of knowledge by examining important and untested relationships.

Background and Significance Adverse events in hospitalized patients increase patient morbidity and mortality and are costly to individuals, hospitals, and society. Tolerance with this status quo is waning. Payers, regulators, insurers and consumers are demanding the delivery of safe healthcare with positive outcomes. VBP places 2 percent of hospital Medicare reimbursement at risk by metrics of quality, outcomes, and experiences of care. Hospitals at EHR Stage 0 may have some clinical systems in place but are considered rudimentary and do not have all three basic ancillary systems installed. Undoubtedly, these Acts have challenged hospital administrators as they appraise the evidence and formulate how to direct valuable human and material resources in efforts to meet the provisions of both the ARRA and the ACA. Despite widespread attention and funding, major gaps in the evidence persist, including exploring the influence of EHRs across differing organizational climates, using relatively small samples of hospitals, and the absence of any multi-site studies to disentangle the complex relationships among EHR, the delivery of nursing care, and patient outcomes.

The study design included adult patients admitted to New Jersey hospitals and nurses employed in those same hospitals. Individuals under the age of 21 were excluded from this study as the focus of the study was adult patients and nurses who are typically older than 21 years. No gender, racial or ethnic groups were excluded. The Institutional Review Board of Rutgers, The State University of New Jersey approved this study. Patient adverse events were derived from the 2006 New Jersey State Inpatient Database, which contains inpatient discharge abstracts and more than 100 clinical and nonclinical data elements such as facility identification number, patient demographics, admission and discharge information, payment source, total charges, and length of stay. HCAHPS is a national, standardized database of patients’ hospital experiences in short-term, acute care hospitals.

The 27-item survey includes categories on communication with doctors and nurses, responsiveness of hospital staff, pain management, cleanliness and quietness of the hospital environment, and medication and discharge instructions. Nurses were also asked to report if any activities, from a set of 12 necessary care activities were left undone during their last shift due to lack of time. EHR adoption data were obtained from the 2006 HIMSS Analytic Database. HIMSS annually surveys a sample of U. Prior to analysis, all datasets were aggregated to the hospital level. The final analytic sample included 854,258 patients and 7,679 nurses in 70 New Jersey hospitals.

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Pearson or Spearman correlations, as determined by the Shapiro-Wilk test of normality. Data were assessed for outliers and missing data. Data on the key variables EMRAM, nursing practice environment, missed nursing care, PSIs and PLOS were available for 70 New Jersey hospitals. In 2006, 51 hospitals submitted readmissions data, and two were excluded from the readmission models due to incomplete data.

All 41 hospitals that submitted HCAHPS data were included in the patient satisfaction models. Bivariate correlations did not significantly identify any potential confounders that required additional testing using adjusted models. The model included the control variables of patient race, being insured, and nurse staffing. As the primary purpose of the study was to examine the effect of EHR adoption levels on patient outcomes, and because the evident and strong relationship among the nursing practice environment and missed nursing care and outcomes might confound this relationship, these variables were controlled to isolate the effect of EHR. Discussion Findings from this study suggest that an inverse relationship exists between EHR adoption stage and the patient outcomes of PLOS and readmissions. The findings of this study did not suggest that increased EHR adoption stages are related to decreased adverse outcomes of PSIs outcomes or increased patient satisfaction. These important relationships have not been tested in prior studies, and as such these novel findings may indicate that at the EMRAM stages 0-4 of EHR adoption, the patient satisfaction benefit is tempered by staffing and resource adequacy.

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