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

描述(由申请人提供)：不理想的处方做法可能会导致门诊设置错误。出现的一项很有前途的技术是电子处方，这项技术允许处方医生以电子方式开具处方。支持者声称，这项技术将提高处方遵从性，节省成本，并改善患者的安全性。 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)和马萨诸塞州蓝十字蓝盾(BCBSMA)和ZixCorporation在马萨诸塞州合作推出电子处方。ZixCorporation的PocketScrip/tm软件是一种电子处方系统，使医生能够以电子方式向药房开具处方并将其传真到药房，识别可能的药物相互作用，提供包括保险级别在内的处方信息，并允许处方医生查看患者的用药历史。 为了检验电子处方是否能改善患者的安全性和降低成本，我们将进行一项同时对照的事前研究，以评估电子处方对不良处方做法(潜在的药物-药物相互作用(DDIS)和剂量问题)、处方遵从性和选定患者结果(慢性病患者的急诊和住院)的影响。为了进行这项研究，Tuft HP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，并将指明哪些处方是以电子方式开具的。 我们假设，电子处方将对不良的处方实践、利用率和成本产生可衡量的影响。如果是这样的话，那么电子处方将被证明是希望改善患者安全的医生的武器库中的一个宝贵武器。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，增加仿制药的使用，而不会对选定的患者群体的结果产生不利影响，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.