Improving Primary Care Patient Safety with Handheld DSS

用药错误在导致患者重大风险的事件中占很大比例，对于抗生素或非甾体抗炎药等常用处方药，许多错误很可能发生在门诊环境中。基于计算机的决策支持系统（DSS）为改进处方模式和同时提高患者安全提供了一种解决方案，但在初级保健环境中使用它们仍有许多未知因素。我们建议开发、实施和评估DSS干预措施，重点是尽量减少使用这些系统影响患者安全的障碍。我们将(1)实施旨在减少医疗差错的决策支持系统；(2)最小化障碍，使系统被使用的概率最大化；(3)系统地评估潜在的或感知到的障碍实际影响决策支持系统使用的程度；最重要的是，(4)评估DSS对患者安全的影响，针对预防非甾体抗炎药处方不当的风险。我们的决策支持干预的目标受众是阿拉巴马州城市学术医疗中心的内科居民和初级保健医生，但主要是在农村地区，他们参加了阿拉巴马州基于实践的研究网络（APBRN）。我们将实施一套决策支持系统，旨在减少医疗错误，并系统地评估潜在或感知障碍实际影响门诊环境中DSS使用的程度。该方法还将包括一项随机对照试验，以评估在处方非甾体抗炎药之前在手持计算机上实施的DSS干预对减少用药错误的影响，以进行适当的风险评估。为了确保所有受试者都接触到可比病例，将使用未公布的标准化患者（SPs）来评估绩效并提供与患者接触期间相互作用的数据。最后，在项目的最后一年，我们将举行一次全州范围的宣传会议，介绍项目的成果。会议的目标是制定一项议程，利用DSS改善整个阿拉巴马州的患者安全。

Medication errors constitute a major proportion of the events that lead to significant risks to patients and, for commonly prescribed medications such as antibiotics or NSAIDS, it is likely that many errors occur in ambulatory settings. Computer-based decision support systems (DSS) offer a solution for improving prescribing patterns and concomitantly improving patient safety, but there are many factors that are still unknown about their use in primary care settings. We propose to develop, implement and evaluate DSS intervention focused on minimizing the barriers to use of these systems to impact patient safety. We will (1) implement decision support systems designed to reduce medical errors; (2) minimize barriers to maximize the probability that the systems will be used; (3) systematically assess the extent to which potential or perceived barriers actually influence DSS use; and, most importantly, (4) assess the impact of DSS on patient safety, targeting preventing the risks of inappropriate prescribing of NSAIDS. Our target audiences for the decision support intervention are internal medicine residents in an urban academic medical center and primary care physicians throughout the state of Alabama, but primarily in rural areas, who participate in the Alabama Practice Based Research Network (APBRN). We will implement a suite of decision support systems that are designed to reduce medical errors and systematically assess the extent to which potential or perceived barriers actually influence DSS use in ambulatory settings. The methodology also will include a randomized controlled trial to assess the impact on medication error reduction of a DSS intervention implemented on a handheld computer for appropriate risk assessment prior to prescribing NSAIDS. To assure that all subjects are exposed to comparable cases, unannounced Standardized Patients (SPs) will be used to assess performance and to provide data on interactions during the patient encounter. Finally, in the last year of the project we will have a statewide dissemination conference describing the results of the project. The conference will be targeted on developing an agenda for usin DSS to improve patient safe throughout the state of Alabama.