Improving Laboratory Monitoring in Community Practices: A Randomized Trial

描述(由申请人提供)：在门诊环境中，用药错误和可预防的不良药物事件在患者中普遍发生，并构成患者安全和质量改进的重要目标。实验室监测以确保药物治疗的安全性和有效性，并及时处理实验室检测的异常结果，已日益被认为是提高门诊护理中患者安全的重要领域。已经为附属于医院和综合交付系统的做法制定了有希望的干预措施，但迄今为止的努力还没有充分惠及在社区单独执业或在小诊所执业的医生。马萨诸塞州e-Health Collaborative(MAeHC；www.maehc.org)为研究社区环境中医疗保健信息技术创新的实施提供了一个重要机会。2007年，MAeHC将为马萨诸塞州三个不同社区的200多个办公室的441名医生完成商业可用的电子健康记录(EHR)的实施。在该州城市和农村地区的这组中小型办公室实践中，我们建议对EHR中的计算机化护理点警报进行集群随机对照试验(RCT)，以防止在药物治疗开始和继续时与实验室监测相关的错误，并建议建立一个结果管理系统，以防止与异常实验室检测的后续延迟相关的错误。我们将：1)确定实验室监测和及时跟踪异常实验室结果的障碍和促进者，特别是对于老年患者和这一人群常见的临床情景；2)设计、实施和评估广泛使用的商业电子健康记录中实验室监测的临床决策支持(护理点警报)的有效性；3)设计、实施和评估结果管理系统的有效性，以改进办公室实践中异常实验室检测结果的及时跟踪；4)制定实用的传播指南，以帮助其他实践和有兴趣实施类似干预措施的社区。这项研究的结果将是重要的，因为它们将证明并加速临床医生使用医疗信息技术来改善患者安全和医疗质量的传播，超越了集成的交付系统，并且应该广泛推广到社区环境中的中小型办公室实践。1改进社区实践中的实验室监测：随机试验。患者在门诊环境中经常发生用药差错，并导致许多可预防的药物不良事件，因此，它们构成了患者安全和质量提高的重要目标。我们提出了以社区为基础的临床决策支持的随机对照试验，以改善对用药的实验室监测，并提出了结果管理计划，以改善对异常实验室测试的及时随访。这项实用的临床试验将评估促进临床医生使用市场上可获得的医疗信息技术来提高门诊护理环境中的用药安全性的有效性。

DESCRIPTION (provided by the applicant): Medication errors and preventable adverse drug events occur commonly among patients in the ambulatory setting and constitute an important target for patient safety and quality improvement. Laboratory monitoring to ensure the safety and effectiveness of drug therapy and the timely management of abnormal results of laboratory testing have been increasingly recognized as important areas for improving patient safety in ambulatory care. Promising interventions have been developed for practices affiliated with hospitals and integrated delivery systems, but efforts to date have not adequately reached physicians practicing solo or in small practices in the community. The Massachusetts e-Health Collaborative (MAeHC; www.maehc.org) provides an important opportunity to study implementation of healthcare information technology innovations in a community setting. In 2007, the MAeHC will complete the implementation of commercially available electronic health records (EHRs) for 441 physicians in more than 200 office practices in three diverse communities in Massachusetts. In this group of small-to-medium sized office practices in both urban and rural regions of the State, we propose a cluster-randomized controlled trial (RCT) of computerized point-of-care alerts in the EHR to prevent errors related to laboratory monitoring at the initiation and continuation of drug therapy and a results management system to prevent errors related to the delay in follow-up of abnormal laboratory testing. We will: 1) identify the barriers to and facilitators of laboratory monitoring and timely follow- up of abnormal laboratory results, especially for elderly patients and clinical scenarios common to this population; 2) design, implement and evaluate the effectiveness of clinical decision support (point-of-care alerts) for laboratory monitoring in a widely used, commercially available EHR; 3) design, implement and evaluate the effectiveness of a results management system to improve the timely follow-up of abnormal laboratory test results in office practice; 4) develop a practical dissemination guide to assist other practices and communities interested in implementing similar interventions. The results of this study will be important because they will demonstrate and accelerate the dissemination of clinicians' use of healthcare information technology to improve patient safety and healthcare quality beyond integrated delivery systems and should be broadly generalizable to small- and medium-sized office practices in community settings. 1 Improving Laboratory Monitoring in Community Practices: A Randomized Trial. Medication errors occur frequently among patients in the ambulatory setting and cause many preventable adverse drug events; thus, they constitute an important target for patient safety and quality improvement. We propose a community-based randomized controlled trial of clinical-decision support to improve laboratory monitoring of medication use and a results management program to improve the timely follow-up of abnormal laboratory tests. This practical clinical trial will evaluate the effectiveness of promoting clinicians' use of commercially available healthcare information technology to improve medication safety in the ambulatory care setting.