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: 6890805
• 负责人: SEAN D SULLIVAN
• 金额: $ 41.62万
• 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/6890805
• 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全国的注意力集中在患者安全问题上，并建议信息技术可能通过减少错误和创造组织效率来提高患者安全。医疗保健研究和质量机构建议，作为一种提高患者安全的策略，实施带有内置临床决策支持（CDS）的计算机化处方单输入（CPOE）系统。迄今为止，这一建议的战略主要在住院和学术环境中实施和评估；在以社区为基础的综合卫生系统的流动环境中较少出现。这个项目的主要目标是在一个流动的、以社区为基础的综合保健系统中实施一个具有CDS能力的CPOE系统，并评估该系统在内部、对组织过程和人为因素的影响；在外部，通过药物错误和药物不良事件来衡量患者安全。这个为期三年的项目有两个具体目标。目标1是在普吉特海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个地点实施门诊CPOE/ CDS系统。我们将记录吸取的经验教训，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后用药错误的流行病学特征，评估门诊CPOE/ CDS系统对患者安全的影响；并将这些错误与不良事件联系起来。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，其中两个匹配的诊所作为对照组。在目标1中，将记录成功的策略和经验教训。将使用回顾性报告机制以及时间和动作分析来捕获工作负载度量。信息技术与人为因素之间的关系将通过对信息提供者的访谈、焦点小组和对卫生专业人员的调查工具的管理来掌握。在目标2中，将使用先验定义和严重程度对10,000张处方进行回顾性评估，以识别和表征药物错误和潜在错误。错误与导致急诊或住院的不良事件有关。所有评估都将比较实施前后的数据。由此产生的手稿将侧重于概括性，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，其中将评价在流动社区环境中执行的国别监测和评估/监测和报告系统，并以有组织和系统的方式传播结果。