title: Comprehensive electronic medical record implementation levels not associated with 30-day all-cause readmissions within Medicare beneficiaries with heart failure.
abstract: BACKGROUND
  Regulatory standards for 30-day readmissions incentivize hospitals to improve quality of care. Implementing comprehensive electronic health record systems potentially decreases readmission rates by improving medication reconciliation at discharge, demonstrating the additional benefits of inpatient EHRs beyond improved safety and decreased errors.
  
  
  OBJECTIVE
  To compare 30-day all-cause readmission incidence rates within Medicare fee-for-service with heart failure discharged from hospitals with full implementation levels of comprehensive EHR systems versus those without.
  
  
  METHODS
  This retrospective cohort study uses data from the American Hospital Association Health IT survey and Medicare Part A claims to measure associations between hospital EHR implementation levels and beneficiary readmissions. Multivariable Cox regressions estimate the hazard ratio of 30-day all-cause readmissions within beneficiaries discharged from hospitals implementing comprehensive EHRs versus those without, controlling for beneficiary health status and hospital organizational factors. Propensity scores are used to account for selection bias.
  
  
  RESULTS
  The proportion of heart failure patients with 30-day all-cause readmissions was 30%, 29%, and 32% for those discharged from hospitals with full, some, and no comprehensive EHR systems. Heart failure patients discharged from hospitals with fully implemented comprehensive EHRs compared to those with no comprehensive EHR systems had equivalent 30-day readmission incidence rates (HR = 0.97, 95% CI 0.73 - 1.3).
  
  
  CONCLUSIONS
  Implementation of comprehensive electronic health record systems does not necessarily improve a hospital's ability to decrease 30-day readmission rates. Improving the efficiency of post-acute care will require more coordination of information systems between inpatient and ambulatory providers.
authors.affiliation: Division of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy , Kansas City, Missouri.
authors.forename: M E
authors.initials: ME
authors.lastname: Patterson
authors.affiliation: Division of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy , Kansas City, Missouri.
authors.forename: P
authors.initials: P
authors.lastname: Marken
authors.affiliation: Department of Biostatistics, University of Kansas Medical Center , Kansas City, Kansas.
authors.forename: Y
authors.initials: Y
authors.lastname: Zhong
authors.affiliation: Department of Informatics Medicine and Personalized Health, University of Missouri-Kansas City , Kansas City, Missouri.
authors.forename: S D
authors.initials: SD
authors.lastname: Simon
authors.affiliation: Ketcherside Group, L.L.C. , Kansas City, Missouri.
authors.forename: W
authors.initials: W
authors.lastname: Ketcherside
mesh_terms: D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D007615:Kansas; D007902:Length of Stay / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D015995:Prevalence; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: Electronic health records; inpatient care; quantitative evaluation