Residential care facility's computerized capability for discharge and transfer summaries, medical provider information and electronic health records in the US

Research Objective: We examined data from a nationally representative sample of residential care facilities (RCFs) to ascertain whether facilities had any computerized capabilities for discharge and transfer summaries, medical provider information or an Electronic Health Record (EHR). RCFs include assisted living residences, board and care homes, congregate care, enriched housing programs, homes for the aged, personal care homes, and shared housing establishments. Study Design: We used the National Survey of Residential Care Facilities (NSRCF) public use file (2010) from the National Center for Health Statistic to conduct a cross-sectional analysis. The unit of analysis was the facility. The dependent variables included having an EHR and whether facilities had any computerized capabilities for discharge and transfer summaries, or medical provider information. Characteristics of facilities included in the analysis included facility size (small, medium or large), ownership (profit or non-profit), Metropolitan Statistical Area (MSA) status (MSA or non-MSA), and chain affiliation (chain, group or multi system versus other). We used Chi Square tests for bivariate analysis and logistic regression for multivariable analysis.

Population: Nationally representative sample of RCFs (n = 2,302). Findings: Approximately 82.6% of RCFs lacked an EHR, 63.2% lacked computerized capabilities for medical provider information and 80.7% lacked computerized capabilities for discharge and transfer summaries. Differences were present for EHRs across location, chain affiliation, facility size and ownership. Differences in having computerized capabilities for medical provider information were present across chain affiliation, facility size, ownership and location. Differences were present across facility size and ownership type for having computerized capabilities for discharge and transfer summaries. In multivariable analysis, absence of computerized capabilities for medical provider information was associated with no chain affiliation (OR=1.3, 1.1-1.7), small or medium sized (OR=2.4, 1.9-3.2, OR=1.6, 1.3-2.0, respectively), and for-profit (OR=2.0, 1.6-2.6).Absence of computerized capabilities for discharge and transfer summaries was associated with small versus large facilities (OR=1.6, 1.2-2.2). Absence of an EHR was associated with: no chain affiliation (OR=1.5, 1.2-2.0) small or medium sized (OR=1.6, 1.2-2.3; OR=1.5, 1.2-2.1 respectively), for-profit (OR=1.7, 1.3-2.3) and MSAs (OR=1.4, 1.03-1.9). Conclusions: Residents in managed living settings face gaps in the use of EHRs, and having computerized capabilities that may improve care coordination across the health care delivery system.

Identifying ways to increase the use of systems that improve processes of care and improve safety for residents of these facilities should be a target for policy makers seeking to improve the quality of care for a growing aging population.