111 General discussion None of the four postulated associations was (strongly) supported by the data. We did not find a significant relation between the EMRAM-score and the number of patients with adverse events (AE), preventable AEs, AE caused by medication, the number of readmissions (RA) and the length of stay (LOS). The lengths of stay of patients with colorectal cancer as measured by DSCA and the level of digitization in Dutch hospitals– main findings chapter 5. This study correlates the level of digitization as measured by EMRAM with postoperative length of stay (LOS) as measured by the Dutch surgical colorectal audit (DSCA). DSCA, started in 2009, is a nationwide audit used to monitor, evaluate and improve quality of care of primary colorectal cancer surgery. It provides feedback to all hospitals in the Netherlands on a set of quality measures and indicators. While digital maturity may lead to better hospital performance and outcomes, hospitals may use it to improve the quality of care. Our hypothesis behind this part of the thesis is that when basic digital clinical functionalities (EMRAM>=3) are available in a hospital, the patients will have a more efficient hospitalization. Efficient communication could prevent medical or organizational mistakes and make it possible to transfer patients from an intensive care unit (ICU) to a general ward and transfer patients from the ward to home without undue delay. We used the post-operative length of stay (LOS) in this study because that is where the presumed effect is expected. Based on these studies the following hypotheses were tested: • Hypothesis 1: In hospitals with more EMR maturity the likelihood of a shorter LOS on average of colorectal cancer surgery patients in the hospital increases. • Hypothesis 2: In hospitals with more EMR maturity the likelihood of a shorter LOS on average in the ICU (Intensive Care Unit) of colorectal cancer surgery patients increases. • Hypothesis 3: The likelihood of a shorter LOS on average of colorectal cancer surgery patients increases in academic affiliated hospitals with more mature IT systems. • Hypothesis 4: The likelihood of a shorter LOS on average in the ICU of colorectal cancer surgery patients increases in academic affiliated hospitals withmore mature EMR systems. In total 72 hospitals, including 30.358 patients were included in this study. A multivariate regression method was used to test differences adjusted for case mix, year of surgery, 8
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