title: A mixed methods study of clinical information availability in obstetric triage and prenatal offices.
abstract: OBJECTIVE
  To determine the effect of availability of clinical information from an integrated electronic health record system on pregnancy outcomes at the point of care.
  
  
  METHODS
  We used provider interviews and surveys to evaluate the availability of pregnancy-related clinical information in ambulatory practices and the hospital, and applied multiple regression to determine whether greater clinical information availability is associated with improvements in pregnancy outcomes and changes in care processes. Our regression models are risk adjusted and include physician fixed effects to control for unobservable characteristics of physicians that are constant across patients and time.
  
  
  RESULTS
  Making nonstress test results, blood pressure data, antenatal problem lists, and tubal sterilization requests from office records available to hospital-based providers is significantly associated with reductions in the likelihood of obstetric trauma and other adverse pregnancy outcomes. Better access to prenatal records also increases the probability of labor induction and decreases the probability of Cesarean section (C-section). Availability of lab test results and new diagnoses generated in the hospital at ambulatory offices is associated with fewer preterm births and low-birth-weight babies.
  
  
  CONCLUSIONS
  Increased availability of specific clinical information enables providers to deliver better care and improve outcomes, but some types of clinical data are more important than others. More available information does not always result from automated integration of electronic records, but rather from the availability of the source records. Providers depend upon information that they trust to be reliable, complete, consistent, and easily retrievable, even if this requires multiple interfaces.
authors.affiliation: Department of Economics, Lehigh University, Bethlehem, Pennsylvania.
authors.forename: Chad D
authors.initials: CD
authors.lastname: Meyerhoefer
authors.affiliation: Department of Management, Lehigh University.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Sherer
authors.affiliation: Department of Economics, Lehigh University, Bethlehem, Pennsylvania.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Deily
authors.affiliation: Department of Economics, Lehigh University, Bethlehem, Pennsylvania.
authors.forename: Shin-Yi
authors.initials: SY
authors.lastname: Chou
authors.affiliation: Research and Evaluation Group, American Institutes for Research, Washington, D.C.
authors.forename: Lizhong
authors.initials: L
authors.lastname: Peng
authors.affiliation: Department of Health Policy and Management, Florida International University, Miami.
authors.forename: Tianyan
authors.initials: T
authors.lastname: Hu
authors.affiliation: Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, Pennsylvania.
authors.forename: Marion
authors.initials: M
authors.lastname: Nihen
authors.affiliation: Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, Pennsylvania.
authors.forename: Michael
authors.initials: M
authors.lastname: Sheinberg
authors.affiliation: Department of Pediatrics, Lehigh Valley Health Network.
authors.forename: Donald
authors.initials: D
authors.lastname: Levick
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data*; D019411:Clinical Laboratory Techniques; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D033181:Information Dissemination; D007751:Labor, Induced / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000458:organization & administration*; D014218:Triage
keywords: electronic health records; information transmission; mixed methods; pregnancy outcome