JMIR Publications

ABSTRACT

Background:

This study demonstrates that digital maturity contributes to strengthened quality and safety performance outcomes in US hospitals. Advanced digital maturity is associated with more digitally enabled work environments with automated flow of data across information systems to enable clinicians and leaders to track quality and safety outcomes. This research illustrates that advanced digitally enabled workforce is associated with a strong safety leadership and culture, stronger patient health and safety outcomes.

Objective:

To examine the relationship between digital maturity and quality and safety outcomes in US hospitals. This was a cross sectional observational study of 1026 US hospitals. Logistic, linear, and Tweedie regressions were used to explore the relationship between The Leapfrog Group's Hospital Safety Grades, individual leapfrog safety scores and digital maturity levels classified as highly advanced digital maturity (level 6 and 7 EMRAM maturity), and early-stage maturity levels (level 0 EMRAM maturity). Hospitals that had completed an EMRAM assessment, were located in the USA, had complete data for their hospital characteristics in the CMS data, and had complete data for The Leapfrog Group's Hospital Safety Grades were included in this study. Hospitals included in the analysis were distributed across all 50 states. Hospitals were divided into two groups to compare safety and quality outcomes; hospitals that are digitally advanced (EMRAM maturity levels 6 or 7) and hospitals with low digital maturity (EMRAM level 0). Data for The Leapfrog Group's Hospital Safety Grades report published in Spring 2019 were matched to the hospitals with completed EMRAM assessments in 2019. Hospital characteristics such as number of hospitals beds were obtained from the CMS data base. Main Outcome(s) and Measure(s): The main outcomes are hospital safety letter grades, and quality and safety scores on a continuous scale, published by The Leapfrog Group. Digital maturity level (EMRAM) was used as a predictor while controlling for hospital characteristics including teaching status, urban or rural location, hospital size measured by number of beds, whether the hospital was a referral center, and type of hospital ownership, as confounding variables.

Methods:

The data sources were hospital safety letter grades, and quality and safety scores on a continuous scale, published by The Leapfrog Group. Digital maturity level (EMRAM) was used from 1026 US hospitals. This was a cross sectional observational study. Logistic, linear, and Tweedie regressions were used to explore the relationship between The Leapfrog Group's Hospital Safety Grades, individual leapfrog safety scores and digital maturity levels classified as highly advanced digital maturity (level 6 and 7 EMRAM maturity), and early-stage maturity levels (level 0 EMRAM maturity). EMRAM was a predictor while controlling for hospital characteristics including teaching status, urban or rural location, hospital size measured by number of beds, whether the hospital was a referral center, and type of hospital ownership, as confounding variables. Hospitals were divided into two groups to compare safety and quality outcomes; hospitals that are digitally advanced and hospitals with low digital maturity. Data for The Leapfrog Group's Hospital Safety Grades report published in Spring 2019 were matched to the hospitals with completed EMRAM assessments in 2019. Hospital characteristics such as number of hospitals beds were obtained from the CMS data base.

Results:

Hospitals were distributed across the United States (all 50 states) with the final sample consisting of n=1026 hospitals. Results revealed that the odds of achieving a higher Leapfrog Group's Hospital Safety Grades is statistically significantly higher by 3.25 folds for hospitals with advanced digital maturity (EMRAM maturity of 6 or 7) (OR=3.25, 95% CI:2.33—4.55). Similarly, hospitals with advanced digital maturity had statistically significantly reduced infection rates, reduced adverse events, and improved surgical safety outcomes.

Conclusions:

Study findings suggest a significant difference in quality and safety outcomes among hospitals with advanced digital maturity, compared to hospitals with low levels of digital maturity.