Hospital Computing and the Costs and Quality of Care: A National Study

Himmelstein, David U.; Wright, Adam; Woolhandler, Steffie

doi:10.1016/j.amjmed.2009.09.004

Cited by 212Electronic Health Records SystemsHealthcare Quality and ManagementHealthcare Policy and Management

Hospital Computing and the Costs and Quality of Care: A National Study

Himmelstein, David U., Wright, Adam, Woolhandler, Steffie·2010·The American Journal of Medicine

DOI 10.1016/j.amjmed.2009.09.004

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Abstract

Background Many believe that computerization will improve health care quality, reduce costs, and increase administrative efficiency. However, no previous studies have examined computerization's cost and quality impacts at a diverse national sample of hospitals.Methods We linked data from an annual survey of computerization at approximately 4000 hospitals for the period from 2003 to 2007 with administrative cost data from Medicare Cost Reports and cost and quality data from the 2008 Dartmouth Health Atlas. We calculated an overall computerization score and 3 subscores based on 24 individual computer applications, including the use of computerized practitioner order entry and electronic medical records. We analyzed whether more computerized hospitals had lower costs of care or administration, or better quality. We also compared hospitals included on a list of the "100 Most Wired" with others.Results More computerized hospitals had higher total costs in bivariate analyses (r=0.06, P=.001) but not multivariate analyses (P=.69). Neither overall computerization scores nor subscores were consistently related to administrative costs, but hospitals that increased computerization faster had more rapid administrative cost increases (P=.0001). Higher overall computerization scores correlated weakly with better quality scores for acute myocardial infarction (r=0.07, P=.003), but not for heart failure, pneumonia, or the 3 conditions combined. In multivariate analyses, more computerized hospitals had slightly better quality. Hospitals on the "Most Wired" list performed no better than others on quality, costs, or administrative costs.Conclusion As currently implemented, hospital computing might modestly improve process measures of quality but does not reduce administrative or overall costs.

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Crossref · 10.1016/j.amjmed.2009.09.004

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Authors: Himmelstein, D. U., Wright, A., & Woolhandler, S.
Affiliations: Harvard University (US)
Corresponding author: Himmelstein, David U.
ORCID: Himmelstein, David U.
Wright, Adam
Woolhandler, Steffie
Venue: The American Journal of Medicine
Publisher: Elsevier BV
Published: 2010-01
Volume: 123
Issue: 1
Pages: 40-46
ISSN: 0002-9343 (ISSN-L)
DOI: 10.1016/j.amjmed.2009.09.004
OpenAlex: W2148157394
Cited by: 212
References: 28
Citations by year: 2026: 4 · 2024: 6 · 2023: 5 · 2022: 11 · 2021: 5 · 2020: 2 · 2019: 11 · 2018: 16 · 2017: 8 · 2016: 15 · 2015: 18 · 2014: 16 · 2013: 18 · 2012: 27
FWCI: 54.18
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: The American Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: Dartmouth College
Topics: Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Keywords: hospital digitalization, health information technology, hospital costs, quality of care, administrative costs, electronic health records, acute myocardial infarction, heart failure, pneumonia
MeSH terms: Cost-Benefit Analysis, Cross-Sectional Studies, Female, Medicare, Hospital Administration, Hospital Information Systems, Humans, Male, Medicaid, Quality of Health Care, Research Design, United States, Multivariate Analysis, Linear Models, Databases, Factual, Medical Records Systems, Computerized, Hospital Costs, Health Care Surveys, Electronic Health Records

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Hospital Computing and the Costs and Quality of Care: A National Study

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