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Objective. To examine the impact of electronic health record (EHR) deployment on Surgical Care Improvement Project (SCIP) measures in a tertiary-care teaching hospital. Data Sources. SCIP Core Measure dataset from the CMS Hospital Inpatient Quality Reporting Program (March 2010 to February 2012). Study Design. One-group pre- and post-EHR logistic regression and difference-indifferences analyses. Principal Findings. Statistically significant short-term declines in scores were observed for the composite, postoperative removal of urinary catheter and post-cardiac surgery glucose control measures. A statistically insignificant improvement in scores for these measures was noted 3 months after EHR deployment. Conclusion. The transition to an EHR appears to be associated with a short-term decline in quality. Implementation strategies should be developed to preempt or minimize this initial decline. Key Words. Quality of care/patient safety (measurement), observational data/quasi-experiments, surgery, Several landmark reports have underscored the importance of health information technology (HIT) in promoting the quality of care (IOM 2001, 2012). The Health Information Technology for Economic and Clinical Health [...]

In the June 1991 issue of The American Journal of Medicine, Frankl et al. report that 28 of 318 hospital readmissions could have been prevented if their previous care had been better. This study used hospital admissions to evaluate quality of care. Although this variable (number of readmissions) is useful in evaluating hospital care, it also possesses a limitation. Quality problems for those readmitted were found in 9 percent of cases. However, these cases only represented 1 percent of all admissions for the period, and in fact about 90 percent of the 9 percent of all admissions were found to not have a quality problem. A more accurate study would need to examine those not readmitted who either did or did not receive the proper care. This study, although useful, does not give a complete picture on the quality of care given in the hospital. It is also unclear how these data relate to the total quality management (TQM) of the hospital. Further studies are required to determine the relationship between readmissions and quality of care. (Consumer Summary produced by Reliance Medical Information, Inc.)

• Screening mammography is underutilized in many primary care practices. We designed a prospective, controlled trial to evaluate two strategies for improving the utilization of mammography in an academic general medicine clinic. We assigned teams of house officers to (1) physician audit with periodic feedback, (2) a visit-based strategy directed at both patient and physician, or (3) a no intervention concurrent control arm. After 6 months, the percentage of 50- to 74-year-old women meeting the standard of an annual mammogram was 36% for patients in the control arm, 62% for patients of feedback residents, and 54% for patients of the arm receiving the visit-based strategy. Patients of female providers were slightly more likely to meet the standard, but no effects were detected for patient race, new as opposed to follow-up patient, or higher frequency of clinic visits. We conclude that audit with feedback and a new visit-based strategy of a patient cue associated with a simplification of the ordering process each greatly improved the rate of utilization of screening mammography. Practitioners could reasonably choose the strategy most suited to their own situation.(Arch Intern Med. 1989;149:2087-2092)

• To identify those clinical findings that independently help differentiate intracranial hemorrhage from cerebral infarction, we studied patients who were admitted to a hospital with acute focal neurologic deficits after strokes during a 17-month period. The predictive strength of a decision-making aid incorporating these findings was then assessed by studying patients who were admitted to a different hospital after experiencing strokes. The decision-making aid stratified the patients into groups having probabilities of intracranial hemorrhage ranging from 5% to 67%. The results of this study may facilitate more discriminatng test selection during the early evaluation of patients who have had strokes.(Arch Intern Med 1985;145:1800-1803)