E-Prescribing Impact on Patient Safety, Use, and Cost

描述（由申请人提供）：次优处方实践可能导致门诊设置错误。 一项很有前途的技术已经出现，那就是电子处方，这是一项允许开处方的人以电子方式开处方的技术。 支持者声称，这项技术将提高处方集的合规性，节省成本，并改善患者安全。 拟议的研究将利用一项大型自然实验，该实验基于塔夫茨健康计划（Tufts HP）、马萨诸塞州蓝十字蓝盾（BCBSMA）和Zix公司在马萨诸塞州全州范围内合作推出的电子处方。 ZixCorporation的PocketScript/tm软件是一种电子处方系统，使医生能够以电子方式编写处方并将处方传真给药房，并识别可能的药物相互作用，提供处方集信息，包括保险等级，并允许处方医生查看患者药物历史。 为了检查电子处方是否会改善患者安全性并降低成本，我们将进行一项前后研究，同时进行对照，以评价电子处方对明显不良处方实践（潜在的药物相互作用（DDI）和给药问题）、处方依从性和选定患者结局（慢性病患者的艾德访视和住院治疗）的影响。 为了进行这项研究，塔夫茨惠普和BCBSMA已同意向我们提供2004年10个月的所有药房和医疗索赔，并将指出哪些处方是电子书写的。 我们假设，电子处方将导致不良处方的做法，利用率和成本的可衡量的影响。 如果是这样的话，那么电子处方将被证明是一个有价值的武器，在武库的医生谁希望提高病人的安全。 然而，即使我们发现对患者安全没有影响，如果我们也能够证明电子处方可以降低成本并增加仿制药的使用，而不会对选定的患者群体产生不利影响，我们的研究也将是重要的。

DESCRIPTION (PROVIDED BY APPLICANT): Suboptimal prescribing practices may result in errors in the outpatient setting. One promising technology that has emerged is e-prescribing, a technology that allows prescribers to write prescriptions electronically. Proponents claim that this technology will result in enhanced formulary compliance, cost savings, and improvements in patient safety. The proposed study will take advantage of a large natural experiment based on a collaborative statewide rollout of e-prescribing in Massachusetts by Tufts Health Plan (Tufts HP) and Blue Cross Blue Shield of Massachusetts (BCBSMA), and ZixCorporation. PocketScript/tm software from the ZixCorporation is an e-prescribing system that enables physicians to electronically write and fax prescriptions to the pharmacy, and identifies possible drug interactions, supplies formulary information including insurance tiers, and allows prescribers to view patient drug history. To examine whether e-prescribing results in improvements in patient safety and reductions in cost, we will conduct a pre-post study with concurrent controls to evaluate the effects of e-prescribing on poor apparent prescribing practices (potential drug-drug interactions (DDIs) and dosing problems), formulary compliance, and selected patient outcomes (ED visits and hospitalization for chronically ill patients). To perform this research, Tufts HP and BCBSMA have agreed to provide us with all pharmacy and medical claims for 10 months of 2004 and will indicate which prescriptions were written electronically. We hypothesize that e-prescribing will result in measurable impacts on poor prescribing practices, utilization, and cost. If so, then e-prescribing will be shown to be a valuable weapon in the arsenal of physicians who wish to improve patient safety. However, our study will be important even if we find no impact on patient safety, if we are also able to show that e-prescribing can reduce costs and increase use of generic medications without adversely affecting outcomes among selected groups of patients.