CC-BY 4.0 · ACI Open 2018; 02(01): e21-e29
DOI: 10.1055/s-0038-1653970
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Interdisciplinary Plans of Care, Electronic Medical Record Systems, and Inpatient Mortality

Joseph D. Bonner
University of Arkansas Medical Sciences (UAMS), Little Rock, Arkansas, United States
,
Brandon J. Stange
Trinity Health, Trinity Information Services, Livonia, Michigan, United States
,
Mindy Kjar
Trinity Health, Trinity Information Services, Livonia, Michigan, United States
,
Margaret A. Reynolds
Trinity Health, Retired
,
Eric Hartz
Trinity Health, Integrated Clinical Services, Clinical Informatics, Livonia, Michigan, United States
,
Donald D. Bignotti
Ascension Health, Warren, Michigan, United States
,
Miriam Halimi
Beaumont Health, Southfield, Michigan, United States
,
Meredith Zozus
University of Arkansas Medical Sciences (UAMS), Little Rock, Arkansas, United States
,
Denise Atherton
Trinity Health, Integrated Clinical Services, Clinical Informatics, Livonia, Michigan, United States
,
Sandra Breck
Trinity Health, Retired
,
Gay Landstrom
Ascension Health, Warren, Michigan, United States
,
Charles Bowling
Trinity Health, Trinity Information Services, Livonia, Michigan, United States
,
Robert Sloan
Trinity Health, Trinity Information Services, Livonia, Michigan, United States
› Author Affiliations
Further Information

Publication History

05 April 2018

05 April 2018

Publication Date:
18 May 2018 (online)

Abstract

Background Interdisciplinary plans of care (IPOCs) guide care standardization and satisfy accreditation requirements. Yet patient outcomes associated with IPOC usage through an electronic medical record (EMR) are not present in the literature. EMR systems facilitate the documentation of IPOC use and produce data to evaluate patient outcomes.

Objectives This article aimed to evaluate whether IPOC-guided care as documented in an EMR is associated with inpatient mortality.

Methods We contrasted whether IPOC-guided care was associated with a patient being discharged alive. We further tested whether the association differed across strata of acuity levels and overall frequency of IPOC usage within a hospital.

Results Our sample included 165,334 adult medical/surgical discharges for a 12-month period for 17 hospitals. All hospitals had 1 full year of EMR use antedating the study period. IPOCs guided care in 85% (140,187/165,334) of discharges. When IPOCs guided care, 2.1% (3,009/140,187) of admissions ended with the patient dying while in the hospital. Without IPOC-guided care, 4.3% (1,087/25,147) of admissions ended with the patient dying in the hospital. The relative likelihood of dying while in the hospital was lower when IPOCs guided care (odds ratio: 0.45; 99% confidence interval: 0.41–0.50).

Conclusion In this observational study within a quasi-experimental setting of 17 community hospitals and voluntary usage, IPOC-guided care is associated with a decreased likelihood of patients dying while in the hospital.

Clinical Relevance Statement

IPOC use as documented in an EMR improves patient mortality. The higher the risk of death, the greater the improvement.