• Marcia M Ward, Smruti Vartak, Jean L Loes, John O'Brien, Troy R Mills, Jonathon R B Halbesleben, and Douglas S Wakefield.
• Center for Health Policy and Research, University of Iowa, Iowa City, 52242, USA. marcia-m-ward@uiowa.edu
• Am J Manag Care. 2020 Dec 5; 18 (5): 244-52.

ObjectivesThis study examines staff perceptions of patient care quality and the processes before and after implementation of a comprehensive clinical information system (CIS) in critical access hospitals (CAHs).Study DesignA prospective, nonexperimental design, evaluation study.MethodsA modified version of the Information Systems Expectations and Experiences (I-SEE) survey instrument was administered to staff in 7 CAHs annually over 3 years to capture baseline, readiness, and postimplementation perceptions.ResultsDescriptive analyses examined 840 survey responses across 3 survey administrations and job categories (registered nurses [RNs], providers, and other clinical staff). Analysis of variance compared responses for main effects (ie, administration, staff position, hospital, and cohort) and interactions between groups over time. Correlations examined the relationships between variables. In general, the responses indicate a high level of positive perceptions regarding the processes and quality of care in these hospitals. For most of the items, responses were quite consistent across the 3 survey administrations. Significant changes occurred for 5 items; 4 reflecting information flow and increased communication, and 1 reflecting a decrease in improved patient care. Overall, providers had lower mean responses compared with nurses and other clinical staff. Significant interactions between administrations and job categories were found for 4 items.ConclusionsEven though staff had overwhelmingly positive perceptions of patient care quality and processes, significant differences between providers, RNs, and other clinical staff were observed. Variability was also found across CAHs. Research on CIS implementation in small hospitals is rare and needed to guide the identification of factors and strategies related to success.

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