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Observational Study
. 2019 Jun 14;9(6):e024700.
doi: 10.1136/bmjopen-2018-024700.

Does hospital information technology infrastructure promote the implementation of clinical practice guidelines? A multicentre observational study of Japanese hospitals

Noriko Sasaki  1 , Naohito Yamaguchi  2 , Akiko Okumura  2 , Masahiro Yoshida  2 , Hiroyuki Sugawara  2 , Yuichi Imanaka  1
Affiliations
Observational Study

Does hospital information technology infrastructure promote the implementation of clinical practice guidelines? A multicentre observational study of Japanese hospitals

Noriko Sasaki et al. BMJ Open. .

Abstract

Objectives: It remains unclear whether insufficient information technology (IT) infrastructure in hospitals hinders implementation of clinical practice guidelines (CPGs) and affects healthcare quality. The objectives of this study were to describe the present state of IT infrastructure provided in acute care hospitals across Japan and to investigate its association with healthcare quality.

Methods: A questionnaire survey of hospital administrators was conducted in 2015 to gather information on hospital-level policies and elements of IT infrastructure. The number of positive responses by each respondent to the survey items was tallied. Next, a composite quality indicator (QI) score of hospital adherence to CPGs for perioperative antibiotic prophylaxis was calculated using administrative claims data. Based on this QI score, we performed a chi-squared automatic interaction detection (CHAID) analysis to identify correlates of hospital healthcare quality. The independent variables included hospital size and teaching status in addition to hospital policies and elements of IT infrastructure.

Results: Wide variations were observed in the availability of various IT infrastructure elements across hospitals, especially in local area network availability and access to paid evidence databases. The CHAID analysis showed that hospitals with a high level of access to paid databases (p<0.05) and internet (p<0.05) were strongly associated with increased care quality in larger or teaching hospitals.

Conclusions: Hospitals with superior IT infrastructure may provide higher-quality care. This allows clinicians to easily access the latest information on evidence-based medicine and facilitate the dissemination of CPGs. The systematic improvement of hospital IT infrastructure may promote CPG use and narrow the evidence-practice gaps.

Keywords: clinical practice guidelines; evidence-based practice; evidence-practice gaps; healthcare quality; hospital IT infrastructure; quality indicators.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow diagram of the subject hospital selection process. *Target QI indicates QI of perioperative antibiotic prophylaxis of the 11 surgical procedures mentioned in the manuscript. QI, quality indicator; QIP, quality indicator/improvement project.
Figure 2
Figure 2
Information sources freely available or specifically provided by the participating hospitals (153 hospitals).
Figure 3
Figure 3
χ2 automatic interaction detection tree diagram showing the correlates of the QI score. *These values indicate the numbers of positive responses to questionnaire items related to (i) electronic health records and internet availability, (ii) wireless LAN availability and (iii) wired LAN availability at outpatient clinics/wards. **P=0.0499, in detail. DB, database; LAN, local area network; QI, quality indicator.
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