The federal government has spent billions of dollars in incentives for health care delivery organizations, including acute care hospitals, to digitize their clinical records and workflow processes by adopting electronic health records (EHRs). However, to date, many of the proposed quality benefits of digitizing health care delivery have not been realized in practice. One reason for this may be the poor performance of clinical decision support systems, which were the primary mechanism by which digitization of health care delivery was expected to improve quality. Hospital scores on a national assessment of clinical decision support capabilities has been uneven, and there is significant variation in performance even within hospitals using the same EHR system. At the same time, there is an ongoing debate regarding the value of these national quality and safety measures and assessments, with many prominent industry voices stating that they do not see value in these types of performance assessments, and the empirical work on health care quality metrics has produced mixed findings. To date, however, there have been few studies regarding the value of quality measures that focus on EHR safety performance.
To determine the value of performance feedback for health care IT systems, I use data from a national quality evaluation program, the Leapfrog CPOE Safety Evaluation, which uses simulated patients and orders to assess hospital clinical decision support performance at preventing medical errors. This voluntary self-assessment is taken by a wide array of hospitals annually. Hospitals receive categorical feedback based on their raw percentage score, i.e. “Full Demonstration of Safety Standards” for a score between 50-100%, compared to “Some Demonstration of Safety Standards” for a score between 30-49.99%. Using a regression discontinuity design, I identify the causal impact of giving hospitals feedback on the results of their IT-enabled quality improvement performance test.
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