Evaluating the Impact of an ACPOE/CDS System on Outcomes

描述(由申请人提供)：医学研究所最近的出版物将全国的注意力集中在患者安全问题上，并表明信息技术可能通过减少差错和提高组织效率来改善患者安全。医疗研究和质量机构建议，作为提高患者安全的一项战略，实施具有内置临床决策支持(CDS)的计算机化处方订单录入(CPOE)系统。到目前为止，这一建议的战略主要在住院和学术环境中实施和评估；较少在以社区为基础的综合卫生系统的门诊环境中实施和评估。该项目的主要目标是在以社区为基础的综合医疗系统中实施具有CDS能力的CPOE系统，并在内部评估该系统对组织流程和人为因素的影响；在外部评估该系统对患者安全的影响，以用药错误和不良药物事件衡量。这个为期三年的项目有两个具体目标。目标1是在北部普吉特湾地区以社区为基础的综合保健系统Everett诊所的所有13个地点实施门诊CPOE/CDS系统。我们将记录吸取的经验教训，并评估该系统对组织工作量流程和使用该系统的卫生专业人员行为的影响。在目标2中，我们将通过描述实施前和实施后用药差错的流行病学特征，并将这些差错与不良事件联系起来，来评估动态CPOE/CDS系统对患者安全的影响。虽然将在所有13个地点实施，但部分评价将在家庭诊所和儿科诊所进行，两个相匹配的诊所作为对照组。在目标1中，将记录用于取得成功的战略和从中吸取的经验教训。将使用回溯报告机制以及时间和动作分析来捕获工作负载指标。信息技术与人的因素之间的关系将通过与报案人面谈、焦点小组和向卫生专业人员管理调查工具来了解。在目标2中，将使用预先定义的定义和严重程度对10,000张处方进行回顾性评估，以识别和描述用药错误和潜在错误的特征。错误将与导致急诊科或医院入院的不良事件有关。所有评价都将比较实施前后的数据。最终的手稿将侧重于概括性，以便外部利益攸关方能够从我们的工作中受益。这将是首批项目之一，其中将对在以社区为基础的流动环境中实施CPOE/CDS系统进行评估，并以有系统的方式传播结果。

DESCRIPTION (provided by the applicant): Recent publications of the Institute of Medicine have focused national attention on issues of patient safety and have suggested that information technology may hold the potential to improve patient safety, by reducing errors and by creating organizational efficiencies. The Agency for Healthcare Research and Quality has recommended, as a strategy to improve patient safety, the implementation of computerized prescriber order entry (CPOE) systems with built-in clinical decision support (CDS). To date, this recommended strategy has been implemented and evaluated primarily in inpatient and academic: settings; less frequently in the ambulatory setting of a community-based, integrated health-system. The primary objectives of this project are to implement a CPOE system with CDS capabilities in an ambulatory, community-based, integrated health-system and to evaluate the impact of the system both internally, on organizational processes and human factors; and externally, on patient safety as measured by medication errors and adverse drug events. This three-year project has two specific aims. Aim 1 is to implement the ambulatory CPOE/ CDS system in all thirteen sites of The Everett Clinic, a community-based integrated health-system in the north Puget Sound region. We will document lessons learned, and evaluate the impact of the system on organizational workload processes and on the behavior of the health professionals who use the system. In Aim 2 we will evaluate the impact of the ambulatory CPOE/ CDS system on patient safety, by characterizing the epidemiology of medication errors pre- and post-implementation; and linking these errors to adverse events. While the implementation will take place in all thirteen sites, portions of the evaluation will take place in both a family practice and a pediatric clinic, with two matched clinics serving as control groups. In Aim 1, strategies used for, and lessons learned in achieving success will be documented. Workload metrics will be captured using both retrospective reporting mechanisms and a time and motion analysis. The relationship between information technology and human factors will be captured via informant interviews, focus groups and administration of a survey instrument to health professionals. In Aim 2, 10,000 prescriptions will be retrospectively evaluated to identify and characterize medication errors and potential errors, using definitions and severity levels defined a priori. Errors will be linked to adverse events that cause emergency department or hospital admissions. All evaluations will compare data pre-to post-implementation. Resultant manuscripts will focus on generalizability so that external stakeholders can benefit, from our work. This will be one of the first projects wherein implementation of a CPOE/CDS system in an ambulatory community-based setting will be evaluated and results disseminated in a structured and systematic way.