- •What is the primary question addressed by this study?How is EHR usability associated with postsurgical outcomes including 30-day readmission, 30-day mortality, and length of stay among older adults with dementia?
- •What is the main finding of this study?Older adults with dementia who received care in hospitals with better EHR usability were less likely to die within 30 days of their admission following surgery compared to hospitals with poorer EHR usability (OR: 0.79, 95% CI: 0.68–0.91, p = 0.001). However, there was no relationship between EHR usability and readmission or LOS.
- •What is the meaning of the finding?Our findings suggested that better EHR usability is associated with reduced 30-day mortality among older adults with dementia. Therefore, improving EHR usability may be beneficial for reducing the likelihood of postsurgical mortality for older adults with dementia.
Electronic health record (EHR) usability, defined as the extent to which the system can be used to complete tasks, can influence patient outcomes. The aim of this study is to assess the relationship between EHR usability and postsurgical outcomes of older adults with dementia including 30-day readmission, 30-day mortality, and length of stay (LOS).
A cross-sectional analysis of linked American Hospital Association, Medicare claims data, and nurse survey data was conducted using logistic regression and negative binominal models.
The dementia population who received care in hospitals with better EHR usability were less likely to die within 30 days of their admission following surgery compared to hospitals with poorer EHR usability (OR: 0.79, 95% CI: 0.68–0.91, p = 0.001). EHR usability was not associated with readmission or LOS.
Better nurse reported EHR usability has the potential to reduce mortality rates among older adults with dementia in hospitals.
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- Population estimate of people with clinical Alzheimer's disease and mild cognitive impairment in the United States (2020–2060).Alzheimer's Dement. 2021; 17: 1966-1975https://doi.org/10.1002/alz.12362
- 2022 Alzheimer’s disease facts and figures.Alzheimer’s Dement. 2022; 18: 700-789https://doi.org/10.1002/alz.12638
- Medicare utilization and expenditures around incident dementia in a multiethnic cohort.J Gerontol - Ser A Biol Sci Med Sci. 2015; 70: 1448-1453https://doi.org/10.1093/gerona/glv124
- Length of hospital stay and dementia: a systematic review of observational studies.Int J Geriatr Psychiatry. 2019; 34: 8-21https://doi.org/10.1002/gps.4993
- Outcomes of dementia: systematic review and meta-analysis of hospital administrative database studies.Arch Gerontol Geriatr. 2016; 66: 198-204https://doi.org/10.1016/j.archger.2016.06.008
State, U.S. Centers for Medicare & Medicaid Services. Chronic Conditions Table: Prevalence, Medicare Utilization and Spending. Available at:https://www.cms.gov/%0AResearch-Statistics-Data-and-Systems/Statistics-Trends-andReports/Chronic-Conditions/CC_Main.html. Accessed August 19, 2022
- Nationwide inpatient prevalence, predictors, and outcomes of Alzheimer's disease among older adults in the United States, 2002-2012.J Alzheimer's Dis. 2015; 48: 361-375https://doi.org/10.3233/JAD-150228
- The impact of hospitalization on readmission, institutionalization, and mortality of people with dementia: a systematic review and meta-analysis.J Alzheimer's Dis. 2018; 64: 735-749https://doi.org/10.3233/JAD-171128
- Postoperative adverse outcomes in surgical patients with dementia: a retrospective cohort study.World J Surg. 2012; 36: 2051-2058https://doi.org/10.1007/s00268-012-1609-x
- Factors predicting perioperative delirium and acute exacerbation of behavioral and psychological symptoms of dementia based on admission data in elderly patients with proximal femoral fracture: a retrospective study.Geriatr Gerontol Int. 2016; 16: 821-828https://doi.org/10.1111/ggi.12560
- Comorbidity and polypharmacy in people with dementia: insights from a large, population-based cross-sectional analysis of primary care data.Age Ageing. 2017; 46: 33-39https://doi.org/10.1093/ageing/afw176
- Association between incident dementia and risk of hospitalization.JAMA. 2012; 307: 165-172https://doi.org/10.1001/jama.2011.1964.Association
- Fragmentation of care in the last year of life: does dementia status matter?.J Am Geriatr Soc. 2022; 70: 2320-2329https://doi.org/10.1111/jgs.17827
- National and regional projections of supply and demand for geriatricians: 2013-2025.Natl Cent Heal Work Anal. 2017;
- Nurse informaticians report low satisfaction and multi-level concerns with electronic health records: results from an international survey. College of Nursing, Seoul National University , Seoul , Republic of Korea; 11 College of Nursing , Instituto Fede.AMIA Annu Symp Proc. 2016; 2016: 2016-2025
- International standards for HCl and usability.Int J Hum Comput Stud. 2001; 55: 533-552https://doi.org/10.1006/ijhc.2001.0483
- Problems with health information technology and their effects on care delivery and patient outcomes: a systematic review.J Am Med Inform Assoc. 2017; 24: 246-250https://doi.org/10.1093/jamia/ocw154
- Electronic health record usability: associations with nurse and patient outcomes in hospitals.Med Care. 2021; 59: 625-631https://doi.org/10.1097/MLR.0000000000001536
- Human factors systems approach to healthcare quality and patient safety.Appl Ergon. 2014; 45: 14-25https://doi.org/10.1016/j.apergo.2013.04.023
- A methodology for studying organizational performance: a multistate survey of front-line providers.Med Care. 2019; 57: 742-749https://doi.org/10.1097/MLR.0000000000001167
- Nurse staffing and the work environment linked to readmissions among older adults following elective total hip and knee replacement.Int J Qual Heal Care. 2016; 28: 253-258https://doi.org/10.1093/intqhc/mzw007
- Variations in nursing baccalaureate education and 30-day inpatient surgical mortality.Nurs Outlook. 2022; 70: 300-308https://doi.org/10.1016/j.outlook.2021.09.009
- Effect of changes in hospital nursing resources on improvements in patient safety and quality of care.Med Care. 2018; 56: 1001-1008https://doi.org/10.1097/MLR.0000000000001002
- Association of hospital nursing and postsurgical sepsis.PLoS One. 2021; 16: 1-11https://doi.org/10.1371/journal.pone.0258787
- Nursing resources linked to postsurgical outcomes for patients with opioid use disorder.Ann Surg Open. 2022; 3: e185https://doi.org/10.1097/as9.0000000000000185
- Adoption of electronic health record systems among U.S. non-federal acute care hospitals: 2008-2015.ONC Data Brief. 2016; 35: 2008-2015https://dashboard.healthit.gov/evaluations/data-briefs/non-federal-acute-care-hospital-ehr-adoption-2008-2015.php
- The “meaningful use” regulation for electronic health records.N Engl J Med. 2010; 363 (Published online): 501-504
- Measures for use with administrative data comorbidity.Care. 2010; 36: 8-27
- Advocating for greater usability in clinical technologies: the role of the practicing nurse.Crit Care Nurs Clin North Am. 2018; 30: 247-257https://doi.org/10.1016/j.cnc.2018.02.007
- A threat to our integrity – meanings of providing nursing care for older patients with cognitive impairment in acute care settings.Scand J Caring Sci. 2016; 30: 48-56https://doi.org/10.1111/scs.12220
- The impact of co-morbidity on the quality of life of people with dementia: findings from the IDEAL study.Age Ageing. 2019; 48: 361-367https://doi.org/10.1093/ageing/afy155
- Risk factors and outcomes of delirium in older patients admitted to postacute care with and without dementia.Dement Geriatr Cogn Disord. 2018; 45: 121-129https://doi.org/10.1159/000485794
- Primary care continuity and potentially avoidable hospitalization in persons with dementia.J Am Geriatr Soc. 2021; 69: 1208-1220https://doi.org/10.1111/jgs.17049
- Relationship between dementia and length of stay of general medical patients admitted to acute care.Australas J Ageing. 2006; 25: 20-23https://doi.org/10.1111/j.1741-6612.2006.00135.x
- Does psychiatric comorbidity increase the length of stay in general hospitals?.Gen Hosp Psychiatry. 2001; 23: 8-14https://doi.org/10.1016/S0163-8343(00)00110-9
- Development of the hospital nurse surveillance capacity profile.Res Nurs Heal. 2009; 32: 217-228https://doi.org/10.1002/nur.20316
- Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being.National Academies Press (US), Washington (DC)2019https://doi.org/10.17226/25521
- The association between perceived electronic health record usability and professional burnout among US physicians.Mayo Clin Proc. 2020; 95: 476-487https://doi.org/10.1016/j.mayocp.2019.09.024
Published online: February 12, 2023
Accepted: February 6, 2023
Received in revised form: February 6, 2023
Received: October 27, 2022
Publication stageIn Press Journal Pre-Proof
Published by Elsevier Inc. on behalf of American Association for Geriatric Psychiatry.