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BMJ：转诊期间使用EHRs对患者不良安全结局的影响

2016-07-29 MedSci MedSci原创

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为了评估住院患者使用电子健康记录(EHRs) 与患者死亡结局，再入院率，和不良安全事件之间的短期关系。进行一项观察性研究，使用双重差异分析。 2011-2012年，17家研究医院的住院患者，有可证实的"go live"使用EHRs的日期，对照组为399家在同一医院转诊区域的医院。 在这些医院使用 EHRs前及使用后90天 (n=28 235 及 26 453名住院患者)的医疗照顾受益中

为了评估住院患者使用电子健康记录(EHRs) 与患者死亡结局，再入院率，和不良安全事件之间的短期关系。进行一项观察性研究，使用双重差异分析。

2011-2012年，17家研究医院的住院患者，有可证实的"go live"使用EHRs的日期，对照组为399家在同一医院转诊区域的医院。

在这些医院使用 EHRs前及使用后90天 (n=28 235 及 26 453名住院患者)的医疗照顾受益中，计算出院后患者30天内的全因再入院率，30天内住院患者的全因死亡率，以及不良反应事件，定义为挑选的患者安全指标(PSI)-90复合测量  ，与对照组同时期同一医院转诊区域的全部入院患者相比较。

结果，在使用EHRs前后，两组间住院患者特征相似。在研究组医院，未调整的30天死亡率 (6.74% - 7.15%, P=0.06)和不良安全事件 (10.5 - 11.4 /1000 住院患者, P=0.34)与使用EHRs后无显著改变。未调整的30天再入院率降低，从19.9% 到19.0%。双重差异分析显示，使用前后的任何结局无明显改变(所有P≥0.13)。

结论：尽管有对急诊转诊期间使用EHRs 可能会造成患者不良安全事件的担忧，但我我们未发现使用前后短期内对住院患者的死亡率有任何影响。

原始出处：

Michael L Barnett,  Ateev Mehrotra,  Anupam B Jena, Adverse inpatient outcomes during the transition to a new electronic health record system: observational study，
BMJ 2016; 354 doi: http://dx.doi.org/10.1136/bmj.i3835 (Published 28 July 2016)


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  1. [GetPortalCommentsPageByObjectIdResponse(id=1848050, encodeId=28d3184805077, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Sun Jun 18 03:50:00 CST 2017, time=2017-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1648583, encodeId=2d05164858310, content=<a href='/topic/show?id=afa493462ec' target=_blank style='color:#2F92EE;'>#转诊#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93462, encryptionId=afa493462ec, topicName=转诊)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=471123610769, createdName=kalseyzl, createdTime=Mon Aug 22 05:50:00 CST 2016, time=2016-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97148, encodeId=32109e14859, content=好好学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Tue Aug 09 22:09:00 CST 2016, time=2016-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95419, encodeId=8d3795419f4, content=很好有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Mon Aug 01 19:45:00 CST 2016, time=2016-08-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464107, encodeId=f95c146410eb3, content=<a href='/topic/show?id=da7d9119bc' target=_blank style='color:#2F92EE;'>#HRS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9119, encryptionId=da7d9119bc, topicName=HRS)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=259a6588710, createdName=ysjykql, createdTime=Sun Jul 31 13:50:00 CST 2016, time=2016-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95217, encodeId=1d1f9521e6f, content=这也可以啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=a37a1710612, createdName=oo902, createdTime=Sun Jul 31 11:14:00 CST 2016, time=2016-07-31, status=1, ipAttribution=)]
    2017-06-18 gaoxiaoe

    #BMJ#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1848050, encodeId=28d3184805077, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Sun Jun 18 03:50:00 CST 2017, time=2017-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1648583, encodeId=2d05164858310, content=<a href='/topic/show?id=afa493462ec' target=_blank style='color:#2F92EE;'>#转诊#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93462, encryptionId=afa493462ec, topicName=转诊)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=471123610769, createdName=kalseyzl, createdTime=Mon Aug 22 05:50:00 CST 2016, time=2016-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97148, encodeId=32109e14859, content=好好学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Tue Aug 09 22:09:00 CST 2016, time=2016-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95419, encodeId=8d3795419f4, content=很好有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Mon Aug 01 19:45:00 CST 2016, time=2016-08-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464107, encodeId=f95c146410eb3, content=<a href='/topic/show?id=da7d9119bc' target=_blank style='color:#2F92EE;'>#HRS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9119, encryptionId=da7d9119bc, topicName=HRS)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=259a6588710, createdName=ysjykql, createdTime=Sun Jul 31 13:50:00 CST 2016, time=2016-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95217, encodeId=1d1f9521e6f, content=这也可以啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=a37a1710612, createdName=oo902, createdTime=Sun Jul 31 11:14:00 CST 2016, time=2016-07-31, status=1, ipAttribution=)]
    2016-08-22 kalseyzl

    #转诊#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1848050, encodeId=28d3184805077, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Sun Jun 18 03:50:00 CST 2017, time=2017-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1648583, encodeId=2d05164858310, content=<a href='/topic/show?id=afa493462ec' target=_blank style='color:#2F92EE;'>#转诊#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93462, encryptionId=afa493462ec, topicName=转诊)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=471123610769, createdName=kalseyzl, createdTime=Mon Aug 22 05:50:00 CST 2016, time=2016-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97148, encodeId=32109e14859, content=好好学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Tue Aug 09 22:09:00 CST 2016, time=2016-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95419, encodeId=8d3795419f4, content=很好有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Mon Aug 01 19:45:00 CST 2016, time=2016-08-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464107, encodeId=f95c146410eb3, content=<a href='/topic/show?id=da7d9119bc' target=_blank style='color:#2F92EE;'>#HRS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9119, encryptionId=da7d9119bc, topicName=HRS)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=259a6588710, createdName=ysjykql, createdTime=Sun Jul 31 13:50:00 CST 2016, time=2016-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95217, encodeId=1d1f9521e6f, content=这也可以啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=a37a1710612, createdName=oo902, createdTime=Sun Jul 31 11:14:00 CST 2016, time=2016-07-31, status=1, ipAttribution=)]
    2016-08-09 忠诚向上

    好好学习

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1848050, encodeId=28d3184805077, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Sun Jun 18 03:50:00 CST 2017, time=2017-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1648583, encodeId=2d05164858310, content=<a href='/topic/show?id=afa493462ec' target=_blank style='color:#2F92EE;'>#转诊#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93462, encryptionId=afa493462ec, topicName=转诊)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=471123610769, createdName=kalseyzl, createdTime=Mon Aug 22 05:50:00 CST 2016, time=2016-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97148, encodeId=32109e14859, content=好好学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Tue Aug 09 22:09:00 CST 2016, time=2016-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95419, encodeId=8d3795419f4, content=很好有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Mon Aug 01 19:45:00 CST 2016, time=2016-08-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464107, encodeId=f95c146410eb3, content=<a href='/topic/show?id=da7d9119bc' target=_blank style='color:#2F92EE;'>#HRS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9119, encryptionId=da7d9119bc, topicName=HRS)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=259a6588710, createdName=ysjykql, createdTime=Sun Jul 31 13:50:00 CST 2016, time=2016-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95217, encodeId=1d1f9521e6f, content=这也可以啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=a37a1710612, createdName=oo902, createdTime=Sun Jul 31 11:14:00 CST 2016, time=2016-07-31, status=1, ipAttribution=)]
    2016-08-01 忠诚向上

    很好有用

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1848050, encodeId=28d3184805077, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Sun Jun 18 03:50:00 CST 2017, time=2017-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1648583, encodeId=2d05164858310, content=<a href='/topic/show?id=afa493462ec' target=_blank style='color:#2F92EE;'>#转诊#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93462, encryptionId=afa493462ec, topicName=转诊)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=471123610769, createdName=kalseyzl, createdTime=Mon Aug 22 05:50:00 CST 2016, time=2016-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97148, encodeId=32109e14859, content=好好学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Tue Aug 09 22:09:00 CST 2016, time=2016-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95419, encodeId=8d3795419f4, content=很好有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Mon Aug 01 19:45:00 CST 2016, time=2016-08-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464107, encodeId=f95c146410eb3, content=<a href='/topic/show?id=da7d9119bc' target=_blank style='color:#2F92EE;'>#HRS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9119, encryptionId=da7d9119bc, topicName=HRS)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=259a6588710, createdName=ysjykql, createdTime=Sun Jul 31 13:50:00 CST 2016, time=2016-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95217, encodeId=1d1f9521e6f, content=这也可以啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=a37a1710612, createdName=oo902, createdTime=Sun Jul 31 11:14:00 CST 2016, time=2016-07-31, status=1, ipAttribution=)]
    2016-07-31 ysjykql

    #HRS#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1848050, encodeId=28d3184805077, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Sun Jun 18 03:50:00 CST 2017, time=2017-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1648583, encodeId=2d05164858310, content=<a href='/topic/show?id=afa493462ec' target=_blank style='color:#2F92EE;'>#转诊#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93462, encryptionId=afa493462ec, topicName=转诊)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=471123610769, createdName=kalseyzl, createdTime=Mon Aug 22 05:50:00 CST 2016, time=2016-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97148, encodeId=32109e14859, content=好好学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Tue Aug 09 22:09:00 CST 2016, time=2016-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95419, encodeId=8d3795419f4, content=很好有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Mon Aug 01 19:45:00 CST 2016, time=2016-08-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464107, encodeId=f95c146410eb3, content=<a href='/topic/show?id=da7d9119bc' target=_blank style='color:#2F92EE;'>#HRS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9119, encryptionId=da7d9119bc, topicName=HRS)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=259a6588710, createdName=ysjykql, createdTime=Sun Jul 31 13:50:00 CST 2016, time=2016-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=95217, encodeId=1d1f9521e6f, content=这也可以啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=a37a1710612, createdName=oo902, createdTime=Sun Jul 31 11:14:00 CST 2016, time=2016-07-31, status=1, ipAttribution=)]
    2016-07-31 oo902

    这也可以啊

    0

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