Comparison of three commercial knowledge bases for detection of drug-drug interactions in clinical decision support
Comparison of three commercial knowledge bases for detection of drug-drug interactions in clinical decision support
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DOI：
10.1093/jamia/ocx010
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发表时间：
2017-07-01
影响因子：
6.4
通讯作者：
Bodenreider, Olivier
中科院分区：
文献类型：
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作者：
Fung, Kin Wah;Kapusnik-Uner, Joan;Bodenreider, Olivier
目的：比较3种商业知识库（KBs）在临床实践中用于检测和避免潜在的药物-药物相互作用（DDI）。方法：将First DataBank（FDB）、Micromedex和Multum的DDI表中的药物映射到RxNorm。在临床药物、成分和DDI规则水平上比较KB。根据国家卫生信息技术协调员办公室（ONC）的高度重要DDI参考列表对KBs进行评价。知识库和ONC列表被应用到处方数据集，以模拟其在临床决策support.Results中的使用：知识库包含160万（FDB），450万（Micromedex）和480万（Multum）临床药物对。总共有860万个独特对，其中79%仅在1 KB中发现，5%在所有3 KB中发现。然而，在严重程度分级方面，尤其是在禁忌类别中，一致性通常多于不一致性。KBs涵盖了ONC列表中99.8-99.9%的警报，并且每1000个处方会生成25个（FDB）、145个（Micromedex）和84个（Multum）警报。结论：商业KBs在生成的警报的大小和数量上存在很大差异。DDI严重程度等级的变异性小于先前研究所建议的。所有KB都提供了ONC列表的非常好的覆盖范围。需要开展更多的工作，使编辑政策和纳入DDI的证据标准化，以减少知识来源之间的差异，提高相关性。在所有3个KB中被视为禁忌的一些DDI可能是添加到ONC列表中的可能候选者。
Objective: To compare 3 commercial knowledge bases (KBs) used for detection and avoidance of potential drug-drug interactions (DDIs) in clinical practice.Methods: Drugs in the DDI tables from First DataBank (FDB), Micromedex, and Multum were mapped to RxNorm. The KBs were compared at the clinical drug, ingredient, and DDI rule levels. The KBs were evaluated against a reference list of highly significant DDIs from the Office of the National Coordinator for Health Information Technology (ONC). The KBs and the ONC list were applied to a prescription data set to simulate their use in clinical decision support.Results: The KBs contained 1.6 million (FDB), 4.5 million (Micromedex), and 4.8 million (Multum) clinical drug pairs. Altogether, there were 8.6 million unique pairs, of which 79% were found only in 1 KB and 5% in all 3 KBs. However, there was generally more agreement than disagreement in the severity rankings, especially in the contraindicated category. The KBs covered 99.8-99.9% of the alerts of the ONC list and would have generated 25 (FDB), 145 (Micromedex), and 84 (Multum) alerts per 1000 prescriptions.Conclusion: The commercial KBs differ considerably in size and quantity of alerts generated. There is less variability in severity ranking of DDIs than suggested by previous studies. All KBs provide very good coverage of the ONC list. More work is needed to standardize the editorial policies and evidence for inclusion of DDIs to reduce variation among knowledge sources and improve relevance. Some DDIs considered contraindicated in all 3 KBs might be possible candidates to add to the ONC list.