A National Report of Nursing Home Quality and Information Technology: Two-Year Trends

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A REMARKABLE transformation is occurring in the nation's use of health information technology (HIT). Health information technology adoption has been spurred on by federal legislation in the past few years, which provided financial incentives for HIT adoption, mostly in acute care.1 Federal strategies continue to promote goals that support research, scientific knowledge, and innovations that show how HIT improves health and health care delivery across all sectors.2 A growing area of evidence concerns the widening gap of HIT adoption across health care organizations, such as varied trend rates of electronic health record adoption in long-term care facilities (LTC).3 Despite recognized values HIT provides to LTC providers, such as error reduction, clinical efficiencies, cost savings, and improved patient outcomes, some LTC providers continue to lag behind in their choice to adopt HIT.4 Furthermore, there is scant evidence focused on HIT adoption and trends in quality measures (QMs). Quality measures, which LTC leaders have collected nationally for years, are used in few studies reporting associations with technology adoption trends. Research reported in this article was undertaken to explore this evidence gap by answering the following research questions: (1) What are the trends in information technology (IT) adoption in US nursing home facilities over 2 years? (2) How are 2-year trends in IT adoption in US nursing homes related to nationally reported QMs?BACKGROUNDThis research is innovative because it includes the first national assessment of nursing home QMs and trends in IT adoption, called IT sophistication. The IT sophistication reflects 3 domains of IT adoption that can be measured: IT capabilities, extent of IT use, and degree of IT integration between internal and external stakeholders (Table 1). These domains are further classified into 3 health care dimensions, including resident care, clinical support, and administrative activities.5 Combining the 9 domains and dimensions into 1 cumulative score, a Total IT Sophistication score can be determined for a facility, representing 10 measurable scales. This measure for nursing homes, developed by the corresponding author, has been extensively tested in nursing homes since 2007.5IT sophistication domains and content areasIn preliminary research examining the IT Sophistication model, 27 content areas have been identified and provide a cumulative measure called Total IT Sophistication for a nursing home. Table 1 illustrates each of the 27 content areas by IT sophistication domain. Not shown in Table 1 are the content items that describe each of these areas that make up the Total IT Sophistication. As an example of the content items, under the domain of IT Capabilities is the content Area called Nursing Processes or Documents That Are Computerized. Content items associated with this Area include staff scheduling, vital signs recording (from monitoring equipment), medication administration, staff workload management, physician orders transcription, care planning/care area assessments, historical record keeping, resident acuity/condition reporting, quality assurance, nursing flow sheet, incident reporting, real-time or continuous minimum data set/resident assessment instrument, and clinical reporting (eg, treatments). Content items associated with each of the content areas are able to be scored and cumulatively provide an overall estimate of Total IT Sophistication for a facility, which can be trended over time.6Nursing home characteristics and QMsTo answer the research questions, primary outcomes are measured using nursing home characteristics and QMs found in a publicly available Minimum Data Set known as Nursing Home Compare.

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