title: The effect of health information technology implementation in Veterans Health Administration hospitals on patient outcomes.
abstract: BACKGROUND
  The impact of health information technology (HIT) in hospitals is dependent in large part on how it is used by nurses. This study examines the impact of HIT on the quality of care in hospitals in the Veterans Health Administration (VA), focusing on nurse-sensitive outcomes from 1995 to 2005.
  
  
  METHODS
  Data were obtained from VA databases and original data collection. Fixed-effects Poisson regression was used, with the dependent variables measured using the Agency for Healthcare Research and Quality Inpatient Quality Indicators and Patient Safety Indicators software. Dummy variables indicated when each facility began and completed implementation of each type of HIT. Other explanatory variables included hospital volume, patient characteristics, nurse characteristics, and a quadratic time trend.
  
  
  RESULTS
  The start of computerized patient record implementation was associated with significantly lower mortality for two diagnoses but significantly higher pressure ulcer rates, and full implementation was associated with significantly more hospital-acquired infections. The start of bar-code medication administration implementation was linked to significantly lower mortality for one diagnosis, but full implementation was not linked to any change in patient outcomes.
  
  
  CONCLUSIONS
  The commencement of HIT implementation had mixed effects on patient outcomes, and the completion of implementation had little or no effect on outcomes.
  
  
  CONCLUSIONS
  This longitudinal study provides little support for the perception of VA staff and leaders that HIT has improved mortality rates or nurse-sensitive patient outcomes. Future research should examine patient outcomes associated with specific care processes affected by HIT.
authors.affiliation: University of California, Philip R. Lee Institute for Health Policy Studies, 3333 California Street, Suite 265, San Francisco, CA 94118, United States. Electronic address: joanne.spetz@ucsf.edu.
authors.forename: Joanne
authors.initials: J
authors.lastname: Spetz
authors.affiliation: VA Boston Healthcare System, 150 S Huntington Ave, Jamaica Plain, MA 02130, United States; Boston University, Boston, MA 02215, United States.
authors.forename: James F
authors.initials: JF
authors.lastname: Burgess
authors.affiliation: VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, United States; Stanford University, 450 Serra Mall, Stanford, CA 94305, United States.
authors.forename: Ciaran S
authors.initials: CS
authors.lastname: Phibbs
keywords: Health information technology; Hospitals; Patient outcomes