Association between electronic health record use and quality of care in high Medicaid nursing homes

Weech-Maldonado; Background: Nursing homes operating in resource-constrained environments typically have lower professional staffing and worse quality. Electronic health records (EHRs) have been utilized as an effective tool to improve the quality of care in nursing homes. This study examines the association between EHR use and the quality of care in high Medicaid nursing homes. Methods: The study used primary and secondary data from Brown University’s Long-Term Care Focus, Nursing Home Compare, Area Health Resource File, and Medicare Cost Reports for the years 2017–2018. The primary survey data was collected through a national mailer to Directors of Nursing (DONs) in high-Medicaid nursing homes. The dependent variable, nursing home quality, was conceptualized using Nursing Home Compare Five-Star Quality Rating System where the higher score represents better quality (1 to 5). The independent variable, EHR score, was a composite measure developed from 23 items. Ordered logistic regression was used to model the relationship between the average EHR score and the quality star rating in high-Medicaid nursing homes. Results: There was a significant positive relationship between the average EHR score and the five-star quality rating. For a one unit increase in the average EHR score, the odds of being in a higher star rating category increases by 50%. Additional factors, such as, being a not-for-profit, having higher occupancy rate, and being located in a higher per capita income county were significantly associated with higher quality. Conclusions: We found that EHR use in high-Medicaid nursing homes was positively associated with improvements in quality. This finding provides additional support to the promising role of EHR in improving quality of care among resource-constrained nursing homes. These under-resourced nursing homes face challenges as it relates to quality, the adoption and use of EHRs may facilitate improvements in quality of care.