Cost, staffing and quality impact of bedside electronic medical record (EMR) in nursing homes

Journal of the American Medical Directors Association

Volumn 11, Issue 7, 2010, Pages 485-493

  Rantz, Marilyn J ^a   Hicks, Lanis ^a   Petroski, Gregory F ^a   Madsen, Richard W ^b   Alexander, Greg ^a   Galambos, Colleen ^b   Conn, Vicki ^a   Scott Cawiezell, Jill ^c   Zwygart Stauffacher, Mary ^d   Greenwald, Leslie ^e  

^a University of Missouri   (United States)

^b UNIVERSITY OF MISSOURI   (United States)

^c UNIVERSITY OF IOWA COLLEGE OF NURSING   (United States)

^d UNIVERSITY OF WISCONSIN EAU CLAIRE   (United States)

^e RTI INTERNATIONAL   (United States)

Author keywords

Advanced practice nurse; Costs; EMR; Nursing homes; Quality indicators

Indexed keywords

AGED; ARTICLE; CONSULTATION; CONTROLLED STUDY; DAILY LIFE ACTIVITY; ELECTRONIC MEDICAL RECORD; GERIATRIC CARE; GERONTOLOGICAL RESEARCH; HEALTH CARE COST; HEALTH CARE QUALITY; HUMAN; INTERVENTION STUDY; MEDICAID; MEDICAL STAFF; MEDICAL TECHNOLOGY; NURSING HOME;

EID: 77956235114     PISSN: 15258610     EISSN: 15389375     Source Type: Journal    
DOI: 10.1016/j.jamda.2009.11.010     Document Type: Article

References (42)

1. Committee on Data Standards for Patient Safety. Institute of Medicine: Key capabilities of an electronic health record system. National Academies Press Web site. Available at: Accessed August 1, 2008. http://www.nap.edu/books/NI000427/html/.
2. Alexander G.L., Wakefield D.S. Information technology sophistication in nursing homes. J Am Med Dir Assoc 2009, 10:398-407.
3. HITSP Enabling Healthcare Interoperability. American National Standards Institute Web site. Available at: Accessed August 11, 2009. http://www.hitsp.org.
4. Alexander G.L. Analysis of an integrated clinical decision support system in nursing home clinical information systems. J Gerontol Nurs 2008, 34:15-20.
5. Alexander G.L., Rantz M., Flesner M., et al. Clinical information systems in nursing homes: An evaluation of initial implementation strategies. Comput Inform Nurs 2007, 25:189-197.
6. Rantz M.J., Popejoy L., Petroski G.F., et al. Randomized clinical trial of a quality improvement intervention in nursing homes. Gerontologist 2001, 41:525-538.
7. Rantz M.J., Vogelsmeier A., Manion P., et al. A statewide strategy to improve quality of care in nursing facilities. Gerontologist 2003, 43:248-258.
8. Rantz M.J., Cheshire D., Flesner M., et al. Helping nursing homes "at risk" for quality problems: A statewide evaluation. Geriatr Nurs 2009, 30:238-249.
9. Bates D.W., Gawande A.A. Improving safety with information technology. N Engl J Med 2003, 348:2526-2534.
10. Dennis K., Sweeney P., Macdonald L., Morse N. Point of care technology: Impact on people and paperwork. Nurs Econ 1993, 11:229-248.
11. Garg A.X., Adhikari N.K., McDonald H., et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes. J Am Med Dir Assoc 2005, 293:1223-1238.
12. Kawamoto K., Houlihan C.A., Balas E.A., Lobach D.F. Improving clinical practice using clinical decision support systems: A systematic review of trials to identify features critical to success. Br Med J 2005, 330:765.
13. Mills E.M., Staggers N. Nurse computer performance: Considerations for the nurse administrator. J Nurs Adm 1994, 24:30-35.
14. Wozar J.A., Worona P.C. The use of online information resources by nurses. J Med Libr Assoc 2003, 91:216-221.
15. Nahm R., Poston I. Measurement of the effects of an integrated, point of care computer system on quality of nursing documentation and patient satisfaction. Comput Nurs 2000, 18:220-229.
16. Abbott P.A., Brocht D. Challenges for data management in long-term care. Essentials of Computers for Nurses 2001, 357-364. McGraw-Hill, New York. 3rd ed. V.K. Saba, K.A. McCormick (Eds.).
17. Ferris N. Long-term care lags in health IT. Government Health IT Web site. Available at: Accessed August 1, 2008. http://govhealthit.com/article90387%201308%201324%201305-Web.
18. Alexander G.L. Issues of trust and ethics in computerized clinical decision support systems. Nurs Adm Q 2006, 30:21-29.
19. Alexander G.L., Madsen D., Herrick S., Russell B. Measuring IT sophistication in nursing homes. Rockville, MD: Agency for Health Care Research and Quality 2008, AHRQ Publication No. 08-0034-CD.
20. Ryden M.B., Snyder M., Gross C.R., et al. Value-added outcomes: The use of advanced practice nurses in long-term care facilities. Gerontologist 2000, 40:654-662.
21. Ejaz F.K., Folmar S.J., Kaufmann M., et al. Restraint reduction: Can it be achieved?. Gerontologist 1994, 34:694-699.
22. Evans L.K., Strumpf N.E., Allen-Taylor L., et al. A clinical trial to reduce restraints in nursing homes. J Am Geriatr Soc 1997, 45:675-681.
23. Neufeld R.R., Libow L.S., Foley W.J., et al. Restraint reduction reduces serious injuries among nursing home residents. J Am Geriatr Soc 1999, 47:1202-1207.
24. Neufeld R.R., Libow L.S., Foley W.J., White H. Can physically restrained nursing home residents be untied safely? Intervention and evaluation design. J Am Geriatr Soc 1995, 43:1264-1268.
25. Strumpf N.E., Evans L.K., Wagner J., Patterson J. Reducing physical restraints: Developing an educational program. J Gerontol Nurs 1992, 18:21-27.
26. Werner P., Koroknay V., Braun J., Cohen-Mansfield J. Individualized care alternatives used in the process of removing physical restraints in nursing homes. J Am Geriatr Soc 1994, 42:321-325.
27. Ray W.A., Taylor J.A., Meador K.G., et al. A randomized trial of a consultation service to reduce falls in nursing homes. JAMA 1997, 278:557-562.
28. Ouslander J.G., Schnelle J.F., Uman G., et al. Predictors of successful prompted voiding among incontinent nursing home residents. JAMA 1995, 273:1366-1370.
29. Schnelle J.F., Newman D., White M., et al. Maintaining continence in nursing home residents through the application of industrial quality control. Gerontologist 1993, 33:114-121.
30. Schnelle J.F., Ouslander J.G., Osterweil D., Blumenthal S. Total quality management: Administrative and clinical applications in nursing homes. J Am Geriatr Soc 1993, 41:1259-1266.
31. Quality Indicators for MDS 2.0: Version 6.3, Optional RUGs III Quarterly 1997, Center for Health System Research and Analysis, University of Wisconsin-Madison, Madison, WI.
32. Rantz M.J., Mehr D.R., Conn V., et al. Assessing quality of nursing home care: The foundation for improving resident outcomes. J Nurs Care Qual 1996, 10:1-9.
33. Rantz M.J., Popejoy L., Mehr D., et al. Verifying nursing home care quality using minimum data set quality indicators and other quality measures. J Nurs Care Qual 1997, 12:54-62.
34. Rantz M.J., Hicks L., Grando V.T., et al. Nursing home quality, cost, staffing, and staff-mix. Gerontologist 2004, 44:24-38.
35. Nursing home quality initiative overview. Centers for Medicare & Medicaid Services Web site. Available at: Accessed March 22, 2006. http://www.cms.hhs.gov/NursingHomeQualityInits/01_overview.asp.
36. Hicks L.L., Rantz M.J., Petroski G.F., et al. Assessing contributors to cost of care in nursing homes. Nurs Econ 1997, 15:205-212.
37. Hicks L.L., Rantz M.J., Petroski G.F., Mukamel D.B. Nursing home costs and quality of care outcomes. Nurs Econ 2004, 22:178-192.
38. Rantz M.J., Alexander G., Galambos C., et al. Evaluation of the use of bedside technology to improve quality of care in nursing facilities: A qualitative analysis. Comput Inform Nurs 2009, in press.
39. Fries B.E., Schneider D.P., Foley W.J., et al. Refining a case-mix measure for nursing homes: Resource utilization groups (RUG-III). Med Care 1994, 32:668-685.
40. Madsen R. Estimation of employee turnover based on tenure-to-date. In: Proceedings of the American Statistical Association: Section on Nonparametric Statistics. Alexandria, VA: American Statistical Association, 2005, p. 1660-1667.
41. Scanlon WG. Nursing workforce: Recruitment and retention of nurses and nursing assistants. Washington, DC: Government Accountability Office (U.S. GAO). May 17, 2001. GAO-01-750 T.
42. Health care workforce status: 2007 Missouri report. Missouri Hospital Association Web site. Available at: Accessed August 1, 2008. http://web.mhanet.com/.