Tools for Optimizing Prescribing, Monitoring and Education

描述（由申报人提供）：与药物相关的收益最大化和风险最小化的努力继续受到次优处方、对患者预后监测不足、处方医师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、不良反应和患者健康结果的高发生率令人无法接受。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、监控和教育的工具（TOP-MED）。我们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。为了实现这些目标，TOP-MED CERT将追求以下具体目标：

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.