Intelligent and Practical Geriatric Prescribing Systems

描述(申请人提供)：老年人不适当的处方和用药是一个主要的公共卫生问题。至少85%的老年人使用一种处方药，据估计，老年人不适当处方的患病率在12%至40%之间。超过17%的老年住院是由于不良药物事件(ADE)，并将随着慢性健康状况下多药的增加而增加。当前的临床决策支持(CDS)系统和商业药物知识库(例如Medi-Span)具有显著改善处方和减少ADE的潜力。然而，这些产品仍然缺乏所需的复杂性和临床深度，无法在不用侵入性且往往不适当的干预措施淹没医生的情况下帮助他们。此外，它们不容易纳入医生的工作流程，导致医生经常忽略他们的建议。美国CareLink建议设计和开发一种专家处方软件GerRx，该软件通过确保医学和成本效益的处方来优化老年处方。GerRx将使用一个复杂、成熟的CDS系统，该系统参考公认的药物指南和处方，并利用相关患者数据来更好地开出处方。GerRx将有两种决策支持模式：咨询模式--积极帮助处方者获得由患者数据补充的相关指南信息，以及审查模式--在输入处方时在后台运行，以审查处方。对于第一阶段，目标是：(1)设计和验证专家处方系统，(2)为3种临床上重要的老年疾病(疼痛、抑郁、心力衰竭)开发专家规则，以及(3)在基于社区的门诊护理环境中设计临床试验。为此，我们将召集一个由老年学和药物专家组成的小组，协助汇编和验证用药规则和知识库。我们招募了一家由165名医生组成的独立诊所来提供用户验收测试。我们将与布朗大学老年学和医疗保健研究中心的Joan Teno博士合作，监督系统疗效的第二阶段临床试验。虽然这项工作将针对老年人群，但我们的目标是开发一种高度可扩展的CDS系统，可以应用于任何医疗领域和任何EMR。GerRX有可能通过预防ADE和在这一脆弱人群中增加正确的剂量和药物使用来改善老年人的生活质量。

DESCRIPTION (provided by applicant): Inappropriate prescribing and medication use in the elderly is a major public health issue. At least 85% of senior citizens use one prescription medication, and it is estimated that the prevalence of inappropriate prescriptions in the elderly is between 12-40%. Over 17% of all geriatric hospitalizations are due to Adverse Drug Events (ADEs) and will increase as polypharmacy of chronic health conditions increases. Current Clinical Decision Support (CDS) systems and commercial medication knowledge bases (e.g. Medi-Span), have the potential to dramatically improve prescribing and reduce ADEs. However, these products still lack the sophistication and clinical depth required to assist physicians without inundating them with intrusive and often inappropriate interventions. Additionally, they are not easily incorporated into the physician workflow resulting in physicians often ignoring their recommendations. US CareLink proposes to design and develop an expert prescription software, GerRx, that optimizes geriatric prescribing by ensuring medically- and cost- effective prescriptions. GerRx will use a sophisticated, proven CDS system which references accepted medication guidelines and formularies and leverages relevant patient data for better prescribing. GerRx will have two modes of decision support: Advisory Mode-actively helps the prescriber acquire relevant guideline information augmented by patient data, and Review Mode-runs unobtrusively in the background to review prescriptions as they are entered. For Phase 1, the Aims are to: (1) design and validate an expert prescribing system, (2) develop expert rules for 3 clinically significant geriatric conditions (pain, depression, heart failure), and (3) design a clinical trial in an community-based ambulatory care setting. To do so, we will assemble a panel of geriatric and medication experts to assist in assembling and validating medication rules and knowledge bases. We have recruited a 165-physician independent practice to provide user-acceptance testing. We will collaborate with Dr. Joan Teno, Center for Gerontology and Health Care Research at Brown University, to oversee a Phase 2 clinical trial of system efficacy. While this work will address geriatric populations, our objective is to develop a highly extensible CDS system that can be applied to any medical domain and any EMR. GerRX potentially can improve the quality of life of the elderly through the prevention of ADEs and increasing the correct dosing and use of medications in this frail population.