Individuals burdened with fragmented medical documentation face a significantly elevated risk, being approximately fivefold more prone to mortality following hospital admission and threefold more likely to necessitate intensive care compared to those with a singular, consolidated health record, according to a recent investigation originating from the United States and disseminated online via the journal BMJ Quality & Safety.
These revelations compel the research team to advocate for enhancements in data accuracy and the implementation of policy shifts within health information management frameworks to bolster patient security and well-being.
The phenomenon of record duplication arises when a single patient is assigned more than one identification number within an electronic health record system; its prevalence is estimated to range between 5% and 10%, the investigators noted.
Although these fragmented records contribute to disjointed care pathways and informational deficits, their precise influence on patient health outcomes remains an area requiring further elucidation, they elaborated.
To conduct their inquiry, the researchers concentrated on critical inpatient outcomes for adult participants, extending up to 89 years of age, who were admitted to one of twelve affiliated healthcare facilities within a substantial US multi-regional health system between July 2022 and June 2023. The measured outcomes encompassed the duration of hospital stays, readmission rates within a 30-day period, emergency interventions, instances requiring intensive care, and in-hospital fatalities.
All participating patients had concluded their care with medical, surgical, or orthopaedic teams. Throughout the study’s timeframe, a comprehensive review of 103,190 medical records was undertaken, identifying 73,275 eligible patients. Within this cohort, 6086 individuals were further assessed; 1698 were found to possess duplicate records, while 4388 did not.
A sophisticated statistical methodology, known as propensity score matching, was employed by the research team. This technique effectively standardizes comparable attributes across distinct subject groups – in this specific instance, those with and those without duplicated medical records.
The subsequent analysis of the collected data indicated that individuals with duplicated records exhibited a demonstrably higher propensity for poorer health results.
In-hospital mortality was observed in 11% of the group with duplicate records, contrasting with 2.5% in the group lacking such duplication. Furthermore, the average hospital confinement extended to 101 hours for duplicated record holders, compared to 74 hours for their counterparts.
Patients presenting with duplicated clinical documentation were more frequently subjected to emergent interventions (6% versus 5%) and demonstrated a greater likelihood of requiring intensive care services (46% versus 19%). The rate of hospital readmission within a month following discharge also registered higher: 12% compared to 11%.
Following the incorporation of adjustments for other potentially confounding variables, such as discharge destination and the level of post-discharge support required, patients with duplicate records were found to be 30% more likely to be readmitted to a healthcare facility.
Moreover, these individuals were 3.5 times more inclined to require intensive care intervention and nearly 5 times more likely to succumb during their hospital stay than those without duplicated records. Their hospitalizations were also, on average, 32% longer.
It is important to acknowledge that this investigation is observational in nature, precluding definitive pronouncements regarding causality. Additionally, the researchers concede several limitations to their findings. These include the inability to quantify the number of diagnoses and prior healthcare encounters. The restriction of data to a solitary health system could also curtail the broader applicability of the results, they cautioned.
“Notwithstanding these constraints, our research illuminates a troubling correlation within our operational framework and underscores the imperative for external systems to probe their own associations, ascertain causal mechanisms, and devise strategies to preclude the creation of duplicate records and/or execute data consolidation with expediency,” the authors stated.
To explicate the observed correlations, the researchers posit that record duplication might impede healthcare providers’ access to crucial information, such as known allergies or a patient’s comprehensive medical history, which could directly influence treatment modalities.
“An ancillary hypothesis pertains to operational efficiency: the existence of duplicate charts may lead to therapeutic delays or erroneous prescriptions as medical teams expend additional effort searching for non-readily available information, navigate through multiple disparate records, or inadvertently overlook critical details,” they further suggested.
“These findings underscore the connection between duplicated medical records and adverse patient outcomes, emphasizing the necessity for further research to comprehend the ramifications of fragmented patient information and for the development of targeted interventions aimed at enhancing data integrity, elevating patient safety standards, and guiding policy modifications in the realm of health information management,” they concluded.
