评估医院流程数字化与医院质量之间的关系--来自德国的证据

IF 3.5 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Journal of Medical Systems Pub Date : 2024-09-13 DOI:10.1007/s10916-024-02101-y
Justus Vogel, Alexander Haering, David Kuklinski, Alexander Geissler
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引用次数: 0

摘要

医院数字化旨在提高效率、降低成本和/或改善医疗质量。为了评估数字化与质量之间的关系,我们研究了流程数字化与流程和结果质量之间的关联。我们使用了 2021 年德国数字雷达(DR)项目的数据,并将这些数据与两个流程指标(股骨骨折后骨合成和髋关节置换手术的术前等待时间,n = 516 和 574)和两个结果质量指标(门诊获得性肺炎住院患者的死亡率,n = 1,074 ;新褥疮病例的比率,n = 1,519 )相结合。对于每个指标,我们都进行了单变量和多变量回归。我们通过指定三个具有不同解释变量的模型来全面衡量流程数字化程度:(1) DR 总分(0(未数字化)至 100(完全数字化)),(2) DR 分值子维度与指标逻辑相关的分数总和,(3) 子维度的单独分数。就流程质量指标而言,除一个指标外,其他指标之间的关联都不显著。DR 评分越高,肺炎患者的死亡率越低(多元回归中的 p < 0.10)。相反,流程数字化程度越高,褥疮病例比例越高(模型(1)和(2)中的 p < 0.01,模型(3)中两个子维度的 p < 0.05)。关于褥疮,我们的发现可能是由于数字化使褥疮病例的诊断、记录和报告更完善,而不是质量更差。不显著和不确定的结果可能是由于指标无法反映医院之间的质量差异和数字化效应。在未来的研究中,我们建议利用纵向数据调查医院内部的影响。
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Assessing the Relationship between Hospital Process Digitalization and Hospital Quality – Evidence from Germany

Hospital digitalization aims to increase efficiency, reduce costs, and/ or improve quality of care. To assess a digitalization-quality relationship, we investigate the association between process digitalization and process and outcome quality. We use data from the German DigitalRadar (DR) project from 2021 and combine these data with two process (preoperative waiting time for osteosynthesis and hip replacement surgery after femur fracture, n = 516 and 574) and two outcome quality indicators (mortality ratio of patients hospitalized for outpatient-acquired pneumonia, n = 1,074; ratio of new decubitus cases, n = 1,519). For each indicator, we run a univariate and a multivariate regression. We measure process digitalization holistically by specifying three models with different explanatory variables: (1) the total DR-score (0 (not digitalized) to 100 (fully digitalized)), (2) the sum of DR-score sub-dimensions’ scores logically associated with an indicator, and (3) sub-dimensions’ separate scores. For the process quality indicators, all but one of the associations are insignificant. A greater DR-score is weakly associated with a lower mortality ratio of pneumonia patients (p < 0.10 in the multivariate regression). In contrast, higher process digitalization is significantly associated with a higher ratio of decubitus cases (p < 0.01 for models (1) and (2), p < 0.05 for two sub-dimensions in model (3)). Regarding decubitus, our finding might be due to better diagnosis, documentation, and reporting of decubitus cases due to digitalization rather than worse quality. Insignificant and inconclusive results might be due to the indicators’ inability to reflect quality variation and digitalization effects between hospitals. For future research, we recommend investigating within hospital effects with longitudinal data.

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来源期刊
Journal of Medical Systems
Journal of Medical Systems 医学-卫生保健
CiteScore
11.60
自引率
1.90%
发文量
83
审稿时长
4.8 months
期刊介绍: Journal of Medical Systems provides a forum for the presentation and discussion of the increasingly extensive applications of new systems techniques and methods in hospital clinic and physician''s office administration; pathology radiology and pharmaceutical delivery systems; medical records storage and retrieval; and ancillary patient-support systems. The journal publishes informative articles essays and studies across the entire scale of medical systems from large hospital programs to novel small-scale medical services. Education is an integral part of this amalgamation of sciences and selected articles are published in this area. Since existing medical systems are constantly being modified to fit particular circumstances and to solve specific problems the journal includes a special section devoted to status reports on current installations.
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