Evaluating the Impact of an ACPOE/CDS System on Outcomes

评估 ACPOE/CDS 系统对结果的影响

• 批准号: 7127250
• 负责人: SEAN D SULLIVAN
• 金额: $ 23.47万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-30 至 2007-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7127250
• 关键词: behavioral /social science research tag; biomedical automation; clinical research; community health services; computer assisted medical decision making; computer human interaction; computer network; cooperative study; epidemiology; family medicine; focus groups; health care facility; health care personnel; health care quality; health care service organization; health services research tag; human subject; interview; longitudinal human study; outcomes research; outpatient care; patient safety /medical error; pediatrics; primary care physician; questionnaires

DESCRIPTION (provided by the applicant): Recent publications of the Institute of Medicine have focused national attention on issues of patient safety and have suggested that information technology may hold the potential to improve patient safety, by reducing errors and by creating organizational efficiencies. The Agency for Healthcare Research and Quality has recommended, as a strategy to improve patient safety, the implementation of computerized prescriber order entry (CPOE) systems with built-in clinical decision support (CDS). To date, this recommended strategy has been implemented and evaluated primarily in inpatient and academic: settings; less frequently in the ambulatory setting of a community-based, integrated health-system. The primary objectives of this project are to implement a CPOE system with CDS capabilities in an ambulatory, community-based, integrated health-system and to evaluate the impact of the system both internally, on organizational processes and human factors; and externally, on patient safety as measured by medication errors and adverse drug events. This three-year project has two specific aims. Aim 1 is to implement the ambulatory CPOE/ CDS system in all thirteen sites of The Everett Clinic, a community-based integrated health-system in the north Puget Sound region. We will document lessons learned, and evaluate the impact of the system on organizational workload processes and on the behavior of the health professionals who use the system. In Aim 2 we will evaluate the impact of the ambulatory CPOE/ CDS system on patient safety, by characterizing the epidemiology of medication errors pre- and post-implementation; and linking these errors to adverse events. While the implementation will take place in all thirteen sites, portions of the evaluation will take place in both a family practice and a pediatric clinic, with two matched clinics serving as control groups. In Aim 1, strategies used for, and lessons learned in achieving success will be documented. Workload metrics will be captured using both retrospective reporting mechanisms and a time and motion analysis. The relationship between information technology and human factors will be captured via informant interviews, focus groups and administration of a survey instrument to health professionals. In Aim 2, 10,000 prescriptions will be retrospectively evaluated to identify and characterize medication errors and potential errors, using definitions and severity levels defined a priori. Errors will be linked to adverse events that cause emergency department or hospital admissions. All evaluations will compare data pre-to post-implementation. Resultant manuscripts will focus on generalizability so that external stakeholders can benefit, from our work. This will be one of the first projects wherein implementation of a CPOE/CDS system in an ambulatory community-based setting will be evaluated and results disseminated in a structured and systematic way.

描述（由申请人提供）：医学研究所最近的出版物将国家的注意力集中在患者安全问题上，并表明信息技术可能通过减少错误和提高组织效率来提高患者安全。医疗保健研究和质量局建议，作为改善患者安全的一项战略，实施内置临床决策支持（CDS）的计算机化处方订单输入（CPOE）系统。到目前为止，这一建议的战略已实施和评价主要是在住院和学术：设置;不太经常在门诊设置的社区为基础的，综合卫生系统。该项目的主要目标是在一个流动的、以社区为基础的综合卫生系统中实施一个具有CDS功能的CPOE系统，并评估该系统对内部组织流程和人为因素的影响;以及对外部患者安全的影响，通过用药错误和药物不良事件来衡量。这个为期三年的项目有两个具体目标。目标1是在普吉湾北部地区以社区为基础的综合卫生系统埃弗雷特诊所的所有13个地点实施流动CPOE/ CDS系统。我们将记录经验教训，并评估该系统对组织工作量流程和使用该系统的卫生专业人员行为的影响。在目标2中，我们将通过描述实施前和实施后用药错误的流行病学特征，并将这些错误与不良事件联系起来，评估门诊CPOE/ CDS系统对患者安全性的影响。虽然实施将在所有13个地点进行，但部分评估将在家庭诊所和儿科诊所进行，两个匹配的诊所作为对照组。在目标1中，将记录为取得成功而采用的战略和吸取的经验教训。将使用回顾性报告机制以及时间和运动分析来捕获时间度量。信息技术与人为因素之间的关系将通过线人访谈、焦点小组和向卫生专业人员管理调查工具来获取。在目标2中，将回顾性评价10，000张处方，以使用先验定义的定义和严重程度水平识别和表征用药错误和潜在错误。错误将与导致急诊室或住院的不良事件有关。所有评估都将比较实施前和实施后的数据。由此产生的手稿将侧重于普遍性，以便外部利益相关者可以从我们的工作中受益。这将是第一批项目之一，在这些项目中，将对在流动社区环境中实施CPOE/CDS系统进行评估，并以结构化和系统化的方式传播结果。

项目成果

Prescriber and staff perceptions of an electronic prescribing system in primary care: a qualitative assessment.

• DOI: 10.1186/1472-6947-10-72
• 发表时间: 2010-11-19
• 期刊: BMC medical informatics and decision making
• 影响因子: 3.5
• 作者: Devine EB;Williams EC;Martin DP;Sittig DF;Tarczy-Hornoch P;Payne TH;Sullivan SD
• 通讯作者: Sullivan SD