Presenter:

Timothy Simcoe

Authors:

Tim Simcoe, Dov Rothman

Chair: Stephen T. Parente; Discussant: Jonathan Ketcham Wed June 7, 2006 8:00-9:30 Room 313

There has been increasing interest over the past decade in using information technology (IT) to improve the quality of medical care provided by U.S. hospitals. For example, the Institutes of Medicine (IOM) frequently highlights the potential role of IT in a series of reports on quality improvement. Evidence for these claims frequently comes from event studies that focus on a particular technology and a narrow range of outcomes—such as prescription error rates following the adoption of Computerized Physician Order Entry (CPOE) systems. However, there is a broader literature on IT and productivity that generally finds substantial variation in the establishment-level benefits of IT adoption. This literature attributes variation in the productivity impact of IT to the presence of complementary business processes and organizational characteristics. This paper will examine the relationship between IT adoption and the quality of care at U.S. hospitals, with a focus on identifying complementarities between IT and particular business processes or local market characteristics. We plan to address the following questions: Do hospitals that adopt IT earlier or use it more intensively provide better quality care? If they do, which dimensions of quality are most influence by IT? Are there complementarities between different kinds of IT or between IT and other clinical technologies? And finally, are there complementarities between IT and other business practices or market characteristics? The primary methodological challenge for this line of research is the potential endogeneity of IT adoption. In particular, we might expect the hospitals adopting a particular technology to be precisely those facilities that will benefit most from it. To address this issue, we consider several approaches for isolating the causal impact of IT on the quality of care. One approach exploits small differences in the timing of adoption, by comparing quality outcomes at hospitals that have implemented IT to those who have contracted for the same technology but not yet implemented it. Another approach uses a statistical method called Inverse Probability of Treatment Weighted (IPTW) estimation, which generalizes propensity-score matching techniques that control for selection on observables to the case of time-varying treatments (i.e. adoption decisions).1 The data for this study come from several sources. Measures of hospital IT adoption come from The Dorenfest Complete IHDS+ Databases 1998-2002. This data contains demographic and information systems data for acute care facilities with 100 beds or more. We also plan to construct clinical technology adoption data using publicly available administrative discharge data from Florida (HCUP) and California (OSHPD). Finally, we measure quality using the Healthcare Cost and Utilization Project (HCUP) quality indicator set, and the Patient Safety Indicator Modules (PSI) available from the Agency for Healthcare Research and Quality (AHRQ).2…