Examining Nursing Home Information Technology Maturity and Antibiotic Use Among Long-Term Care Residents

Abstract

Objectives: Up to 15% of the 1.4 million US nursing home (NH) residents receive antibiotics daily. Antibiotic use in NHs is often inappropriate, contributing to quality and safety concerns as well as antibiotic resistance. Information technology (IT) maturity-defined as the extent to which facilities possess and use diverse technological devices and software that are integrated across resident care, clinical support, and administrative activities-may improve the tracking and reporting of antibiotic use in NH residents. Thus, this research explores trends in IT maturity over time and associations with antibiotic use in US NHs.

Design: Repeated cross-sectional study.

Setting and participants: Long-term resident assessments from a random sample of Medicare-certified US NHs over 4 consecutive years (2013-2017).

Methods: Three data sources were used: (1) 4 annual surveys measuring IT maturity, (2) Minimum Data Set (MDS) 3.0 assessments for resident characteristics, and (3) Certification and Survey Provider Enhanced Reporting data for facility characteristics. Nonadmission MDS assessments that were within a 90-day window of the IT survey were eligible. Descriptive statistics were examined. Bivariate and multivariate regressions using NH fixed effects were conducted controlling for resident and NH characteristics.

Results: There were 219,461 MDS assessments from 80,237 long-stay residents aged ≥65 years, living in 817 NHs. Trends in IT maturity increased significantly over 4 years. IT integration in administrative processes was positively associated with antibiotic use (AOR 1.072, 95% CI 1.025, 1.122).

Conclusions and implications: IT components that integrate administrative activities, which can provide greater access to data sources across the organization as a whole, was associated with changes in antibiotic use. Further evaluation is needed to determine if antibiotic use is more appropriate with higher maturity such that policy makers can encourage IT with these capabilities to promote antibiotic stewardship.

Keywords: Nursing homes; antibiotics; medical informatics; technology.