| Adverse events in hospitalized patients are catastrophic and costly to individuals, hospitals and society. The use of electronic health records (EHR) is one promising system-level initiative that may improve provider performance, interdisciplinary communication, reduce adverse patient events, improve the overall quality of patient care, and ultimately improve patient satisfaction with hospital care. The study purpose was to examine the relationships among: (1) EHR adoption stage, (2) missed nursing care and (3) nursing practice environment, on hospitalized patient adverse outcomes and satisfaction.;This secondary analysis of cross sectional data was compiled from four sources: (1) the State Inpatient Database, (2) Healthcare Information and Management Systems Society Dorenfest Institute database of EHR adoption, (3) Hospital Consumer Assessment of Healthcare Providers and Systems Survey, and (4) a survey of New Jersey hospital-based nurses. The analytic approach used ordinary least squares and multiple regression models to estimate the effects of EHR adoption on the delivery of nursing care and patient outcomes, controlling for characteristics of patients, nurses, and hospitals. Robust procedures with Huber-White sandwich variance estimators and clustered means were used to account for the clustering of patients within hospitals. The final analytic sample consisted of 854,258 patients and 7,679 nurses in 70 New Jersey hospitals.;Significant findings from this study indicate positive relationships between nursing practice environment and patient satisfaction, and inverse relationships between: (a) advanced EHR adoption and adverse outcome of prolonged length of stay, (b) nursing practice environment and missed nursing care and (c) missed nursing care and patient satisfaction. Among the subscales of the nursing practice environment tested, staffing and resource adequacy was the strongest predictor of missed nursing care and patient satisfaction.;Further, findings indicate strong, significant relationships among staffing and resource adequacy, missed nursing care and patient satisfaction, and that these strong relationships are not confounding the effects of EHR adoption stage on patient satisfaction. These important findings suggest that sufficient staffing and resources is essential for advanced EHR adoption and patient reported outcomes of satisfaction. These findings may also signify that the patient benefits of advanced technology will only be realized in context of sufficient human resources. |
