14 Chapter 1 the quality of care.14 The question is whether this association actually exists and to what extent especially in Dutch hospitals. To investigate this relationship, at first (chapter 3) we compared the quality and safety measures as used in Elsevier’s annual publication ‘The Best Hospitals’. Elsevier used select data from the publicly available basic quality and the safety set of the Health Care Inspectorate (IGJ) and the Dutch Health Care Transparency Program ‘Zichtbare Zorg’ (ZIZO) program. The next step (chapter 4) of this part of the study was to compare the adverse events and unplanned readmissions as measured by the Netherlands Institute for Health Services Research (NIVEL). NIVEL conducted three patient safety measurements with patient records from 2004, 2008 and 2011/2012, to keep track of changes in patient safety at a national level. As the EMRAM study took place in 2012-2014 we used the last study in 2011/2012 of this study of seventeen hospitals shared in the NIVEL study as well in the underlying EMRAM studies. For the last part (chapter 5) of the second sub question to examine the relationship between the EMRAM score and the quality of care we used the postoperative length of stay (LOS) as measured by the Dutch surgical colorectal audit (DSCA). DSCA 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. The purpose of the third sub question (chapter 6) is to examine the relationship between EMR use and the influencing factors according to the medical specialist. As there are indications that the role of the medical specialist is a particularly important factor in the ‘adoption and use’ of EMR systems in hospitals 15, we conducted a study of the role of the medical specialist toward the adoption of electronic medical records. Physicians are a main frontline user-group of EMR systems. Hence, it requires physicians to actively support and use EMR systems to benefit optimally from their use. To optimise EMR use, it is essential to understand what physicians perceive to be key factors that either support or hinder the use of EMR systems to positively impact the delivered medical treatment and care. The aim of this study was to examine how, and by which aspects, the relationship between EMR use and quality of care in hospitals is influenced according to medical specialists.
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