Hospital quality of care: Does information technology matter? The relationship between information technology adoption and quality of care

Planning for Hospital IT Implementation: A New Look at the Business Case

Compared to organizations in other industries, hospitals are slow to adopt information technology (IT). Those planning for system implementation must understand the barriers to IT adoption which, in healthcare, include the relatively high acquisition and maintenance costs of sophisticated administrative and clinical information systems. Understanding the overall business case is particularly important for hospital IT planners. This paper describes the literature that examines benefits from using health IT. In addition, we focus on a series of studies conducted in Florida that provide generalizable evidence regarding the overall business case associated with hospital adoption for information systems. These studies focus broadly on the improved financial, operational, and clinical performance associated with IT.

Searching for a business case for quality in Medicaid managed care

BACKGROUND

Despite the prevalence of evidence-based interventions to improve quality in health care systems, there is a paucity of documented evidence of a financial return on investment (ROI) for these interventions from the perspective of the investing entity.

PURPOSES

To report on a demonstration project designed to measure the business case for selected quality interventions in high-risk high-cost patient populations in 10 Medicaid managed care organizations across the United States.

METHODOLOGY/APPROACH

Using claims and enrollment data gathered over a 3-year period and data on the costs of designing, implementing, and operating the interventions, ROIs were computed for 11 discrete evidence-based quality-enhancing interventions.

FINDINGS

A complex case management program to treat adults with multiple comorbidities achieved the largest ROI of 12.21:1. This was followed by an ROI of 6.35:1 for a program which treated children with asthma with a history of high emergency room (ER) use and/or inpatient admissions for their disease. An intervention for high-risk pregnant mothers produced a 1.26:1 ROI, and a program for adult patients with diabetes resulted in a 1.16:1 return. The remaining seven interventions failed to show positive returns, although four sites came close to realizing sufficient savings to offset investment costs.

PRACTICE IMPLICATIONS

Evidence-based interventions designed to improve the quality of patient care may have the best opportunity to yield a positive financial return if it is focused on high-risk high-cost populations and conditions associated with avoidable emergency and inpatient utilization. Developing the necessary tracking systems for the claims and financial investments is critical to perform accurate financial ROI analyses.

Multimodal multidisciplinary standardization of perioperative care: still a long way to go

PURPOSE OF REVIEW

The complexity of the perioperative care process has resulted in a suboptimal use of resources, quality problems and a relatively high incidence of errors. In an attempt to optimize resources, patient safety, and quality, multimodal, multidisciplinary standardization of the care process has become an increasingly recognized goal.

RECENT FINDINGS

The anaesthesiologist as perioperative clinician plays a pivotal role in the development and implementation of standardized perioperative care. Historically, however, a significant portion of perioperative care has relied upon anecdotal information that represents an amalgam of any individual anaesthesiologist's collective influences and experiences. Current status of standardized perioperative care and different factors that influence successful implementation of guidelines, fast track surgery programs and clinical pathways are described.

SUMMARY

Although recent literature indicates that standardization of perioperative care improves efficiency, quality, and patient satisfaction, implementation of standardized care is difficult since resistance is still enormous.