Ashish Jha

..Strategies might include reducing copayments for certain medications or providing feedback about adherence to patients and providers through electronic health records...

..To update the status of electronic health record (EHR) adoption in US hospitals and assess their readiness for "Meaningful Use" (MU)...

..Pay for performance has become a central strategy in the drive to improve health care. We assessed the long-term effect of the Medicare Premier Hospital Quality Incentive Demonstration (HQID) on patient outcomes...

..Hospital boards of directors can play a pivotal role in improving care, yet we know little about how the boards of hospitals that disproportionately serve minority patients engage in this issue...

..To better understand the extent and nature of the problem of unsafe care, the WHO World Alliance for Patient Safety commissioned an overview of the world's literature on patient safety research...

..6 billion (5.5 percent of total inpatient costs). Eliminating redundant tests would have saved an additional $8 billion (2.7 percent). Addressing these situations could generate major savings to the system while improving patient care...

..Despite a consensus that the use of health information technology should lead to more efficient, safer, and higher-quality care, there are no reliable estimates of the prevalence of adoption of electronic health records in U.S. hospitals...

..Data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey provide a portrait of patients' experiences in U.S. hospitals...

..Given that a small group of providers care for most racial/ethnic minorities, we sought to determine whether minority-serving providers adopt EHR systems at comparable rates to other providers...

..To assess the state of health information technology (HIT) adoption and use in seven industrialized nations...

..Whether this program helps identify high-quality hospitals is unknown. A study was conducted to determine whether hospitals that report patient safety practice activities have better quality of care or clinical outcomes...

..Most monitors have been developed in large academic hospitals and are not readily usable in other settings. We assessed the ability of a commercial program to identify and prevent ADEs in a community hospital...

..These findings suggest that adopting EHRs should be a major policy goal of health reform measures targeting hospitals that serve large populations of poor patients...

..The large differences in board activities between high-performing and low-performing hospitals we found suggest that governing boards may be an important target for intervention for policymakers hoping to improve care in U.S. hospitals...

..We know little about how U.S. hospitals perform on the current discharge metrics, the factors that underlie better performance, and whether better performance is related to lower readmission rates...

..These findings underscore the fact that the transition to a digital health care system is likely to be a long one...

..Providing financial incentives to hospitals to improve quality is increasingly common, yet its effect on hospitals that care for poor patients is largely unknown...

..In contrast to the private sector, there is little variation in the degree of racial disparities in 30-day mortality across VA hospitals, although higher mortality among patients with AMI and pneumonia requires further investigation...

..To determine whether patterns of electronic health record (EHR) adoption and "meaningful use" vary between high-, intermediate-, and low-quality US hospitals...

..The worst institutions in particular will have to improve on both costs and quality to avoid incurring financial penalties and exacerbating disparities in care...

..To determine the proportion of US hospitals engaged in health information exchange (HIE) with unaffiliated providers and to identify key hospital-level and market-level factors associated with participating in exchange...

..Our finding that care for Hispanics is concentrated among a small number of hospitals provides an opportunity for targeted efforts to improve care for this group of Americans...

..They provided modestly worse care for acute myocardial infarction and congestive heart failure but had comparable rates of risk-adjusted mortality. We found no evidence that low-cost providers provide better care...

..Gender differences in inpatient quality of care are well known. However, whether men and women receive equivalent ambulatory care is less well understood...

..Nevertheless, performance was not associated with a subsequent change in market share. Surgeons with the highest mortality rates were much more likely than other surgeons to retire or leave practice after the release of each report card...

..Large gaps in knowledge, including information about EHR use among safety-net providers, pose critical challenges for the development of policies aimed at speeding adoption...

..If incorrect, this assumption may misestimate disparities. We sought to determine whether clinical factors affect treatment decisions for blacks and whites equally...

..The Hospital Quality Alliance (HQA) is the first initiative that routinely reports data on hospitals' performance nationally. Heretofore, such data have been unavailable...

..The relationship between high HQA performance and lower risk-adjusted mortality is an important validation for this national hospital quality rating program...

..We evaluated the effect of a performance measurement program instituted by the Veterans Health Administration in 1995 to improve vaccination rates...

..We sought to evaluate differences in medical care and clinical outcomes among black and white women with established coronary artery disease...

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..Hospitals face increasing pressure to lower cost of care while improving quality of care. It is unclear if efforts to reduce hospital cost of care will adversely affect quality of care or increase downstream inpatient cost of care...

..Computerised monitors can detect and, with clinical intervention, often prevent or ameliorate adverse drug events (ADEs). We evaluated whether a computer-based alerting system was useful in a community hospital setting...

..Yet we know little about why some efforts succeed while others fail. We sought to identify factors associated with RHIO viability...

..To understand whether racial disparities in surgery for lower-extremity arterial disease are minimized by high-quality providers, or instead, differential treatment of otherwise similar patients pervades all settings...

..Comprehensive knowledge about the level of healthcare information technology (HIT) adoption in the United States remains limited. We therefore performed a baseline assessment to address this knowledge gap...

..Computerized clinical knowledge mana-gement systems hold enormous potential for improving quality and efficiency. However, their impact on clinical practice is not well known...

..There is increasing policy interest in public reporting and tying financial incentives to metrics of patient safety. How black-serving hospitals fare on these measures will have important implications for disparities in care...

..We sought to understand the impact of the CMS payment policy on infection prevention efforts...

..We sought to describe changes in the duration of adult primary care visits and in the quality of care provided during these visits and to determine whether quality of care is associated with visit duration...

..It is unknown whether PSIs are related to standard quality metrics...

..To examine the relationship between race and mortality in frail community-dwelling older people with access to a program providing comprehensive access and coordination of services...

..CONCLUSIONS: For the decade of the 1990s, we found no evidence, either nationally or locally, that efforts to eliminate racial disparities in the use of high-cost surgical procedures were successful...

Julia Adler-Milstein and Ashish Jha Regional health information organizations--RHIOs--are springing up in the United States to meet a vital need: to connect the nation's disparate patient-health information systems...

..Our findings raise concerns about the ability of the current approach to achieve widespread electronic clinical data exchange...

..Smaller stakeholders, such as home health care agencies, will lag in adoption. Policy changes, such as financial incentives to HIT end users or regulatory measures, may help accelerate the adoption of HIT for a model NHIN...

..The utility of the prostate-specific antigen (PSA) test to screen for prostate cancer has been widely debated for several years. Whether PSA testing rates have changed during this period of controversy is not well known...

..The high costs and limited data on financial benefits of CPOE systems are a major barrier to adoption. The authors assessed the costs and financial benefits of the CPOE system at Brigham and Women's Hospital over ten years...

..The use of information technology may result in a safer and more efficient health care system. However, consensus does not exist about the structure or costs of a national health information network (NHIN)...

..We assess the outcomes of patients with colon and rectal cancers at hospitals with a high proportion of Medicaid patients...

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..These data suggest that the quality-improvement initiatives adopted by the VA in the mid-1990s were effective...

..To estimate racial differences in mortality at 30 days and up to 2 years following a hospital admission for the elderly with common medical conditions...

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