Is there a relationship between hospital process digitalization and quality of care? Observational study using data from hospital quality report cards and the DigitalRadar Project

Hospital digitalization is to reduce costs, increase efficiency and productivity, and to improve quality of care. However, the literature lacks clarity on the meaning of "hospital digitalization," how to measure it, and what quality it might affect. We use data from the DigitalRadar project from 2021 describing - amongst other dimensions - process digitalization. We combine these statistically sensitive data with two process (pre-operative waiting time for osteosynthesis and hip replacement after femur fracture) and two risk-adjusted outcome quality indicators (inpatient mortality ratio of patients hospitalized with outpatient-acquired pneumonia, ratio of new cases with inpatient-acquired decubitus/ ulcers). We use multivariate linear regression with the respective quality indicator as dependent variable and different digitalization sub-dimensions as independent variables. Overall, we find no significant correlation between outcome or process quality and the majority of sub-dimensions. Only digitalization of documentation and diagnosis shows a consistently positive and weakly significant correlation with the ratio of new cases with a decubitus/ ulcer. We argue that this lack of statistical significance is in part due to the insufficient statistical sensitivity of the available quality indicators. Moreover, available and routinely measured quality indicators seem not to be apt to reflect digitalization effects. We conclude that empiric assessment of a digitalization-quality relationship needs the development of more fitting and sensitive quality indicators. Otherwise, study designs such as small-scale pre-post intervention assessments of the introduction of specific software will remain the gold standard in digitalization-quality research.