title: Achieving Adherence to Evidence-Based Practices: Are Health IT and Hospital-Physician Integration Complementary or Substitutive Strategies?
abstract: In response to evolving policies and conditions, hospitals have increased health information technology (HIT) adoption and strived to improve hospital-physician integration. While evidence suggests that both HIT and integration confer independent benefits, when combined, they may provide complementary means to achieve high performance or overlap to offset each other's contribution. We explore this relationship in the context of hospital adherence to evidence-based practices (EBPs). Using the American Hospital Association's Annual and IT Supplement surveys, and Centers for Medicare and Medicaid Services's Hospital Compare, we estimate the independent relationships and interactions between HIT and hospital-physician integration with respect to EBP adherence. HIT adoption and tight (but not loose) integration are independently associated with greater adherence to EBPs. The interaction between HIT adoption and tight integration is negative, consistent with an offsetting association between HIT adoption and integration in their relationship to EBP adherence. This finding reveals the need to be aware of potential substitutive effects from simultaneous pursuit of multiple approaches to performance improvement.
authors.affiliation: University of Michigan, Ann Arbor, MI, USA jeverson@umich.edu.
authors.forename: Jordan
authors.initials: J
authors.lastname: Everson
authors.affiliation: University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Shoou-Yih Daniel
authors.initials: SD
authors.lastname: Lee
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Adler-Milstein
mesh_terms: D004059:Diffusion of Innovation; D017598:Efficiency, Organizational; D055317:Evidence-Based Practice / Q000592:standards*; D006761:Hospitals; D006801:Humans; D008490:Medical Informatics / Q000379:methods*; D010820:Physicians; D014481:United States
keywords: evidence-based care; health information technology; hospitals; hospital–physician integration