Improving Primary Care Patient Safety with Handheld DSS

给药错误在导致患者重大风险的事件中占很大比例，对于常用处方药（如抗生素或NSAIDS），许多错误可能发生在门诊环境中。基于计算机的决策支持系统（DSS）提供了一个解决方案，以改善处方模式，并伴随着提高患者的安全性，但有许多因素仍然是未知的，他们在初级保健环境中的使用。我们建议开发、实施和评估DSS干预措施，重点是最大限度地减少使用这些系统影响患者安全的障碍。我们将（1）实施旨在减少医疗错误的决策支持系统;（2）最大限度地减少障碍，以最大限度地提高系统使用的可能性;（3）系统地评估潜在或感知障碍实际影响DSS使用的程度;最重要的是，（4）评估DSS对患者安全的影响，旨在预防NSAIDS处方不当的风险。我们的决策支持干预的目标受众是内科住院医师在城市学术医疗中心和初级保健医生在整个亚拉巴马州，但主要是在农村地区，谁参加了亚拉巴马基于实践的研究网络（APBRN）。我们将实施一套决策支持系统，旨在减少医疗差错，并系统地评估潜在或感知障碍实际影响DSS在门诊环境中使用的程度。该方法还将包括一项随机对照试验，以评估在处方NSAIDS之前在手持计算机上实施DSS干预对减少用药错误的影响，以进行适当的风险评估。为确保所有受试者均暴露于可比病例，将使用未经通知的标准化患者（SP）评估表现并提供患者就诊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。会议将针对制定一个议程，为使用DSS，以提高病人安全整个亚拉巴马州。

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.