Tools for Optimizing Prescribing, Monitoring and Education

描述(由申请人提供)：药物的最大效益和最小风险的努力继续受到以下因素的阻碍：不理想的处方，对患者结果的监测不足，以及克服这些限制的处方者教育和支持不足。其结果是，美国医疗体系长期存在药物使用不足、过度使用和滥用的问题，可预防的差错率高得令人无法接受，不良影响和患者健康结果不佳。为了解决这些问题，我们提出了一个围绕以下主题组织的CERT：优化预描述、监测和教育的工具(TOP-MED)。我们CERT的长期目标是通过增加处方的适当性和监测质量来提高药物治疗的安全性、有效性和成本效益。短期目标是在五个关键领域开发、重新设计、改进、整合、测试、部署和传播工具和培训材料：药物处方、药物利用审查、实验室-药房联系、N-of-1试验和药物经济学。为实现这些目标，TOP-MED CERT将追求以下具体目标： 1.重振药物处方，使之成为指导药物治疗决定的循证工具。 2.重新设计药品使用审查(DUR)系统和流程，使数据分析更容易、更及时，更有可能得出有效的结论。 3.通过将实验室和药房信息系统联系起来，并在发现问题时发出临床警报，减少处方错误，并加强对高危环境中不良药物影响的认识。 4.开发、部署和评估N-of-1试验服务，并将其纳入处方限制方案，以支持个体化治疗的目标，而不屈服于现在经常成为常态的不安全、不科学的试验。 5.实施和研究药物经济学支持对提高处方决策的影响，以及评估其他干预措施的成本效益。 贯穿这五个目标的举措将是：以更严格和更深远的方式传播和部署这些工具；提供支持，使这些工具更易于使用；提高处方医生使用这些工具的积极性和积极性；将这些工具相互联系起来，以便在多个机构之间实现更大的协同作用，并分享所获得的知识和教训。TOPMED CERT总部设在伊利诺伊大学芝加哥分校(UIC)，通过与库克县卫生服务局、西北纪念医院、华盛顿大学、退伍军人管理局药物安全中心、倡导者医疗保健、伊利诺伊州医院协会和伊利诺伊州公共卫生部的合作，TOPMED CERT将能够专注于多个AHRQ优先人群的需求。

DESCRIPTION (Provided by the Applicant): Efforts to maximize the benefits and minimize the risks associated with drugs continue to be impeded by suboptimal prescribing, inadequate monitoring of patients' outcomes, and inadequate prescriber education and support to overcome these limitations. As a result, the US healthcare system suffers from persistent problems of underuse, overuse and misuse of drugs, with unacceptably high rates of preventable errors, adverse effects and suboptimal patient health outcomes. To address these problems, we propose a CERT organized around the following theme: Tools for Optimizing Prescribing, Monitoring and Education (TOP-MED). The long term objective of our CERT is to improve the safety, efficacy and cost-effectiveness of drug therapy by increasing the appropriateness of prescribing and the quality of monitoring. The short term objective is to develop, redesign, refine, integrate, test, deploy and disseminate tools and training materials in five key areas: drug formularies, drug utilization review, lab-pharmacy linkages, N-of-1 trials and pharmacoeconomics. To achieve these objectives, the TOP-MED CERT will pursue the following specific aims: 1. Revitalize the drug formulary as an evidenced based tool for directing drug therapy decisions. 2. Re-engineer drug usage review (DUR) systems and processes so that data analysis is easier, more timely and more likely to yield valid generalizations. 3. Reduce prescribing errors and enhance recognition of adverse drug effects in high hazard contexts by linking lab and pharmacy information systems and generating clinical alerts when problems are detected. 4. Develop, deploy and evaluate an N-of-1 trial service, integrated into a formulary restriction program, in order to support the goal of individualized therapy without succumbing to the unsafe, unscientific experimentation that is often now the norm. 5. Implement and study the impact of pharmacoeconomic support to enhance formulary decision making, as well as evaluate the cost-effectiveness of other interventions. Cutting across these five aims will be initiatives to disseminate and deploy these tools in a more rigorous and far-reaching fashion; to provide support to make the tools easier to use; to enhance the buy-in, motivation and enthusiasm of prescribers to use the tools; to link the tools with each other in order to gain greater synergies, and to share the knowledge gained and lessons learned across multiple institutions. Headquartered at the University of Illinois at Chicago (UIC), and leveraging collaborations with the Cook County Bureau of Health Services, Northwestern Memorial Hospital, University of Washington, the VA Center for Medication Safety, Advocate Health Care, the Illinois Hospital Association and the Illinois Department of Public Health, the TOPMED CERT will be able to focus on the needs of multiple AHRQ priority populations.