Tools for Optimizing Prescribing, Monitoring and Education

优化处方、监测和教育的工具

• 批准号: 7686747
• 负责人: BRUCE L. LAMBERT
• 金额: $ 99.78万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-01 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7686747
• 关键词: Tools; Optimizing; Prescribing; Monitoring; Education

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.

描述（由申请人提供）：最大化药物相关获益和最小化药物相关风险的努力继续受到次优处方、患者结局监测不足以及处方者教育和支持不足（以克服这些限制）的阻碍。因此，美国医疗保健系统遭受药物使用不足、过度使用和滥用的持续问题，可预防的错误、不良反应和次优患者健康结果的发生率高得令人无法接受。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：优化处方，监测和教育工具（TOP-MED）。我们的CERT的长期目标是通过提高处方的适当性和监测的质量来提高药物治疗的安全性、有效性和成本效益。短期目标是开发、重新设计、完善、整合、测试、部署和传播五个关键领域的工具和培训材料：药物处方集、药物利用审查、实验室与药房的联系、1个试验中的N个试验和药物经济学。为了实现这些目标，TOP-MED CERT将追求以下具体目标： 1.振兴药物处方集，作为指导药物治疗决策的证据为基础的工具。 2.重新设计药物使用审查（DUR）系统和流程，使数据分析更容易，更及时，更有可能产生有效的概括。 3.通过连接实验室和药房信息系统，减少处方错误，并在检测到问题时生成临床警报，提高对高危害环境中药物不良反应的识别。 4.开发，部署和评估一个N-of-1试验服务，整合到一个处方限制计划中，以支持个性化治疗的目标，而不屈服于不安全，不科学的实验，这通常是现在的常态。 5.实施和研究药物经济学支持的影响，以加强处方决策，以及评估其他干预措施的成本效益。 贯穿这五个目标的将是以下举措：以更严格和更广泛的方式传播和部署这些工具;提供支持，使这些工具更容易使用;提高处方者使用这些工具的接受度、动机和热情;将这些工具相互联系起来，以获得更大的协同作用，并在多个机构之间分享所获得的知识和吸取的经验教训。总部设在伊利诺伊大学芝加哥分校（UIC），并利用与库克县卫生服务局，西北纪念医院，华盛顿大学，药物安全VA中心，倡导医疗保健，伊利诺伊州医院协会和公共卫生伊利诺伊州部的合作，TOPMED CERT将能够专注于多个AHRQ优先人群的需求。