Measuring Clinical Information Technology in the ICU Setting: Application in a Quality Improvement Collaborative
- Ruben Amarasingham,
- Peter J Pronovost,
- Marie Diener-West,
- Christine Goeschel,
- Todd Dorman,
- David R Thiemann,
- Neil R Powe
- Affiliations of the authors: Department of Care Management and Outcomes Research (RA), Parkland Health & Hospital System, Dallas, TX; Department of Medicine (RA), University of Texas Southwestern Medical School, Dallas, TX; Department of Anesthesiology and Critical Care Medicine (PJP, TD), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics (MD-W), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Michigan Health & Hospital Association (CG), Keystone Center for Patient Safety and Quality, Detroit, MI; Departments of Cardiology and Health Sciences Informatics, (DRT), School of Medicine; Department of Epidemiology (DRT), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (NRP), School of Medicine; Departments of Epidemiology and Health Policy & Management (NRP), 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; e-mail: < >
- Received 2 September 2006
- Accepted 8 February 2007
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.
The authors thank the Robert Wood Johnson Clinical Scholars Program and the Agency for Healthcare Research and Quality (1UC1HS14246) for their support of this work.