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Peter Lindenauer, MD, MSc; November 2006
A woman with end stage renal disease and heart disease on anticoagulation receives a pneumonia vaccination that causes a large hematoma.
Journal Article > Study
Hospital implementation of computerized provider order entry systems: results from the 2003 Leapfrog Group quality and safety survey.
Hillman JM, Given RS. J Healthc Inf Manag. Fall 2005;19:55-65.
The Leapfrog Group's widely recognized efforts to promote patient safety include an initiative to mandate implementation of computerized provider order entry (CPOE) systems at hospitals across the country. This survey of more than 840 participating hospitals demonstrated that while only 3.7% use fully implemented systems, 92% shared plans for at least partial implementation of a CPOE system. Discussion includes analysis of the organizational and financial characteristics of participating hospitals, how hospitals with full implementation differ from those with partial efforts, and various predictors of implementation. Few statistically significant organizational factors were correlated to the variability in CPOE implementation, including profitability, bed size, or penetration of health care maintenance organizations (HMOs). The authors suggest that ongoing changes to financial incentives in health care, such as pay-for-performance, will continue to promote adoption of these technologies that support patient safety.
Journal Article > Study
Cutler DM, Feldman NE, Horwitz JR. Health Aff (Millwood). 2005;24:1654-1663.
This study discovered that implementation of computerized physician order entry (CPOE) systems is a greater reflection of hospital ownership and teaching status than hospital profitability. Using Leapfrog survey data derived from their efforts to reward CPOE adoption, investigators present findings from hospitals with varying degrees of operational CPOE systems. While many have argued that limitation in resources prevents wider implementation, these findings counter those explanations. Interestingly, government hospitals represented the most likely adopters and for-profit organizations the least likely, adding to the notion that these systems are not intended to provide significant profits. Findings suggest that other factors, such as caring for the sickest patients or political interests in safety, may partly explain the results. The authors express concern that less than 5% of hospitals are in compliance with CPOE standards and that changes in the reimbursement environment through federal initiatives may provide necessary stimulus.
The Commonwealth Fund Commission on a High Performance Health System. New York, NY: The Commonwealth Fund; August 2006.
This report calls for providing "safe, well-coordinated, accessible, and efficient" care through five key steps: expanding health insurance coverage, implementing evidence-based patient safety and quality interventions, increasing use of health information technology, public reporting of safety and quality measures, and rewarding achievement in quality through "pay-for-performance." The authors ascribe the current quality problems in the U.S. health care system to system failures, including misaligned payment incentives, inadequate motivation to challenge the status quo, inadequate information systems, duplicative regulatory systems, and an overemphasis on autonomy.
Journal Article > Review
Hwang RW, Herndon JH. Clin Orthop Relat Res. 2007;457:21-34.
The authors discuss the financial incentives of improving patient outcomes as the business case for patient safety.