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Measuring Clinical Information Technology in the ICU Setting: Application in a Quality Improvement Collaborative

^a Department of Care Management and Outcomes Research, Parkland Health & Hospital System, Dallas, TX
^b Department of Medicine, University of Texas Southwestern Medical School, Dallas, TX
^c Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
^d Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
^e Michigan Health & Hospital Association, Keystone Center for Patient Safety and Quality, Detroit, MI
^f Departments of Cardiology and Health Sciences Informatics, School of Medicine, Johns Hopkins University, Baltimore, MD
^g Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
^h Department of Medicine, School of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
ⁱ Departments of Epidemiology and Health Policy & Management, Bloomberg School of Public Health and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD.

^_* Correspondence and reprint requests: Ruben Amarasingham, MD, MBA, Medical Director of Medicine Services, 5123 Harry Hines Blvd, Support Bldg. B, Parkland Health & Hospital System, Dallas, Texas 75235 (Email: ramara{at}parknet.pmh.org).

Received for publication: 09/02/06; accepted for publication: 02/08/07.

Objective: Few instruments are available to measure the performance of intensive care unit (ICU) clinical information systems. Our objectives were: 1) to develop a survey-based metric that assesses the automation and usability of an ICU’s clinical information system; 2) to determine whether higher scores on this instrument correlate with improved outcomes in a multi-institution quality improvement collaborative.

Design: This is a cross-sectional study of the medical directors of 19 Michigan ICUs participating in a state-wide quality improvement collaborative designed to reduce the rate of catheter-related blood stream infections (CRBSI). Respondents completed a survey assessing their ICU’s information systems.

Measurements: The mean of 54 summed items on this instrument yields the clinical information technology (CIT) index, a global measure of the ICU’s information system performance on a 100 point scale. The dependent variable in this study was the rate of CRBSI after the implementation of several evidence-based recommendations. A multivariable linear regression analysis was used to examine the relationship between the CIT score and the post-intervention CRBSI rates after adjustment for the pre-intervention rate.

Results: In this cross-sectional analysis, we found that a 10 point increase in the CIT score is associated with 4.6 fewer catheter related infections per 1,000 central line days for ICUs who participate in the quality improvement intervention for 1 year (95% CI: 1.0 to 8.0).

Conclusions: This study presents a new instrument to examine ICU information system effectiveness. The results suggest that the presence of more sophisticated information systems was associated with greater reductions in the bloodstream infection rate.