title: Measuring clinical information technology in the ICU setting: application in a quality improvement collaborative.
abstract: OBJECTIVE
  Few instruments are available to measure the performance of intensive care unit (ICU) clinical information systems. Our objectives were: 1) to develop a survey-based metric that assesses the automation and usability of an ICU's clinical information system; 2) to determine whether higher scores on this instrument correlate with improved outcomes in a multi-institution quality improvement collaborative.
  
  
  METHODS
  This is a cross-sectional study of the medical directors of 19 Michigan ICUs participating in a state-wide quality improvement collaborative designed to reduce the rate of catheter-related blood stream infections (CRBSI). Respondents completed a survey assessing their ICU's information systems.
  
  
  METHODS
  The mean of 54 summed items on this instrument yields the clinical information technology (CIT) index, a global measure of the ICU's information system performance on a 100 point scale. The dependent variable in this study was the rate of CRBSI after the implementation of several evidence-based recommendations. A multivariable linear regression analysis was used to examine the relationship between the CIT score and the post-intervention CRBSI rates after adjustment for the pre-intervention rate.
  
  
  RESULTS
  In this cross-sectional analysis, we found that a 10 point increase in the CIT score is associated with 4.6 fewer catheter related infections per 1,000 central line days for ICUs who participate in the quality improvement intervention for 1 year (95% CI: 1.0 to 8.0).
  
  
  CONCLUSIONS
  This study presents a new instrument to examine ICU information system effectiveness. The results suggest that the presence of more sophisticated information systems was associated with greater reductions in the bloodstream infection rate.
authors.affiliation: Medicine Services, Parkland Health & Hospital System, Dallas, TX 75235, USA. ramara@parknet.pmh.org
authors.forename: Ruben
authors.initials: R
authors.lastname: Amarasingham
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: Marie
authors.initials: M
authors.lastname: Diener-West
authors.forename: Christine
authors.initials: C
authors.lastname: Goeschel
authors.forename: Todd
authors.initials: T
authors.lastname: Dorman
authors.forename: David R
authors.initials: DR
authors.lastname: Thiemann
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
mesh_terms: D002404:Catheterization / Q000009:adverse effects; D003430:Cross-Sectional Studies; D006751:Hospital Information Systems / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000592:standards; D008824:Michigan; D011785:Quality Assurance, Health Care; D018805:Sepsis / Q000517:prevention & control*; D011795:Surveys and Questionnaires