The unintended consequences of computerized provider order entry: findings from a mixed methods exploration.
The unintended consequences of computerized provider order entry: findings from a mixed methods exploration.
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DOI：
10.1016/j.ijmedinf.2008.07.015
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发表时间：
2009-04-01
影响因子：
4.9
通讯作者：
Guappone, Kenneth
中科院分区：
文献类型：
--
作者：
Ash, Joan S;Sittig, Dean F;Guappone, Kenneth
目的：描述一项为期4年的研究项目的重点、活动、方法和结果。方法：采用混合方法，从实地调查和专家会议中收集380例计算机供应商订单录入(CPOE)意外后果的案例，并将其分为9类。然后我们在美国进行了一项全国性调查，以发现不同输液水平的医院如何识别和处理意想不到的后果。研究小组在专家的协助下，确定了管理九种意外不良后果的策略，并为CPOE实施者开发和传播工具，以帮助解决这些后果。结果：医院报告输液水平相当高，这些类型的意外后果很常见。避免或管理意外后果的策略类似于文献中发表的CPOE成功的最佳实践。结论：使用定性方法制定CPOE意外不良后果类型的分类使我们能够制定一项全国性调查，并发现这些后果的广泛性。使用混合方法，我们也能够构建一种方法来处理对意外后果的巧妙管理。
OBJECTIVE: To describe the foci, activities, methods, and results of a 4-year research project identifying the unintended consequences of computerized provider order entry (CPOE).METHODS: Using a mixed methods approach, we identified and categorized into nine types 380 examples of the unintended consequences of CPOE gleaned from fieldwork data and a conference of experts. We then conducted a national survey in the U.S.A. to discover how hospitals with varying levels of infusion, a measure of CPOE sophistication, recognize and deal with unintended consequences. The research team, with assistance from experts, identified strategies for managing the nine types of unintended adverse consequences and developed and disseminated tools for CPOE implementers to help in addressing these consequences.RESULTS: Hospitals reported that levels of infusion are quite high and that these types of unintended consequences are common. Strategies for avoiding or managing the unintended consequences are similar to best practices for CPOE success published in the literature.CONCLUSION: Development of a taxonomy of types of unintended adverse consequences of CPOE using qualitative methods allowed us to craft a national survey and discover how widespread these consequences are. Using mixed methods, we were able to structure an approach for addressing the skillful management of unintended consequences as well.