59 Patient safety outcomes and their association with the level of digitization in Dutch hospitals the AE: surgery, drug/fluid, medical procedure, diagnostic, other clinical management, discharge or other. AEs that occurred during the patient’s index hospital admission1*, and were detected during either the index admission or subsequent admissions over the following 12month period, were counted. Also counted were AEs related to patient admissions in the same hospital within the 12 months preceding the index admission but that were not detected until the index admission. Consequently, patient records of the index hospital admission were reviewed, as were the patient records of patient admissions before and after the index admission. The way the AEs were counted was the same for all periods of measurement. We selected patient outcomes in the NIVEL database that might be influenced by a higher EMRAM score: the number of AEs, medication related AEs, the number of unplanned readmissions and the length of stay (LOS) in the hospital. For the LOS, our thesis behind this study is that when basic 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. STATISTICAL ANALYSIS We used descriptive statistical techniques to describe the effect of more advanced EMR facilities in hospitals on the number of adverse events (AE), the preventable AEs and the medication related AEs (MRAE). Further analyses on patient level were performed. After weighing for the sample frame, the total study sample was representative of the total Dutch population of hospitalized patients.10 Multilevel binomial regression (adverse events and unplanned readmissions) and linear regression analyses (length of stay) were performed to analyze the relation between the EMRAM groups (independent variable) and respectively, the number of AEs, 1 * As the EMRAM study took place in 2012-2014 only patients measured in 2011/2012 of this large retrospective patient record review study were used. 4
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