The Effect of EMR on Medication Safety: A SPUR-Net Study

描述(申请人提供)：美国每年有44,000至98,000人死于医疗差错。一种常见的医疗错误涉及用药错误(例如，开错药或给错药，剂量不正确，药物相互作用，未能订购治疗监测测试)。有关用药差错的数据主要是在医院收集的，在那里更容易监测此类差错并识别经历药物不良事件的患者。然而，在美国，大多数药物是由初级保健医生在门诊环境下开出的。虽然计算机化的医嘱录入系统(CPOE)已经被证明可以减少住院患者的用药差错，但它们在门诊设置的护理点的效果还没有得到很好的研究。这项为期两年的研究的具体目标是，与使用纸质医疗记录(PMR)但没有高级决策支持的初级保健环境相比，在使用电子病历(EMR)并在护理点提供高级决策支持的初级保健环境中，确定用药错误的频率、类型、严重性和可预防性。这项研究将在四个临床环境中进行，每个环境代表南方初级保健城市研究网络(SPUR-Net(SM))的一个组成组织，该网络位于得克萨斯州休斯顿，由贝勒医学院管理。两个站点使用EMR，逻辑师(R)，两个站点使用PMR。研究将分三个阶段进行。在第一阶段，将从500名成年患者(每个站点125名)中随机抽样，他们将在索引研究访问中获得新的处方。将获得医疗记录审查(第二阶段)的同意，其中将提取诊断代码(ICD-9)、药物和毒性/治疗监测测试结果。第三阶段将包括在指数访问的两周内进行电话访谈，以评估处方配药情况和所经历的重大症状。医疗差错将使用修改后的《布里格姆和妇女用药安全协议》和全国医疗差错报告和预防医疗差错分类协调委员会进行识别和分类。评分者之间的可靠性将在10%的随机患者样本中进行评估。几个支线网合作组织已经采用了电子病历，而其他合作伙伴则计划在未来实施电子病历。因此，我们有机会利用这一自然实验来测试EMR与PMR相比在减少初级保健环境中的用药差错方面的影响。这项拟议的研究具有创新性，因为它将提供对不同初级保健人群中用药差错的了解，并评估具有计算机化决策支持的计算机化医嘱输入系统在减少用药差错方面的效果。此外，这些结果将从根本上促进我们对药物安全的了解和促进。

DESCRIPTION (provided by applicant): Every year, from 44,000 to 98,000 people in the United States die as a result of medical errors. One common medical error involves medication error (e.g., prescribing or administering the wrong medication, incorrect dosing, drug interactions, failure to order therapeutic monitoring tests). Data on medication errors are collected predominantly in hospitals, where it is easier to monitor such errors and to identify patients experiencing adverse drug events. However, in the United States, most medications are prescribed by primary care physicians in the outpatient setting. While computerized physician order entry systems (CPOE) have been shown to decrease medication errors in the inpatient setting, their effect at the point of care in the outpatient setting has not been well studied. The specific aim of this two-year study is to determine the frequency, type, severity, and preventability of medication errors in primary care settings that use an electronic medical record (EMR), with advanced decision support at the point of care, compared with primary care settings where a paper medical record (PMR), without advanced decision support, is used. The study will be conducted in four clinical settings, each representing one constituent organization of the Southern Primary Care Urban Research Network (SPUR-Net(SM)), which is located in Houston, Texas, and administered by Baylor College of Medicine. Two sites use an EMR, Logician(R), and two use PMR. The study will proceed in three phases. In phase I, a random sample of 500 adult patients (125 from each site) who receive a new prescription at the index study visit will be recruited. Consent will be obtained for a medical record review (phase II), where diagnostic codes (ICD-9), medications, and toxic/therapeutic monitoring test results will be abstracted. Phase III will involve a telephone interview occurring within two weeks of the index visit to assess prescription fill and significant symptoms experienced. Medication errors will be identified and classified using a modified version of the Brigham and Women's Medication Safety Protocol and the National Coordinating Council for Medication Error Reporting and Prevention Classification of Medication Errors. Inter-rater reliability will be assessed in a random 10-percent sample of patients. Several of the SPUR-Net partnering organizations have adopted an EMR, while other partners have plans for implementing an EMR in the future. We therefore have the opportunity to use this natural experiment to test the impact of an EMR, compared with a PMR, in reducing medication errors in primary care settings. The proposed research is innovative, as it will provide an understanding of medication errors in a diverse primary care population and assess the effect of computerized physician order entry system with computerized decision support in decreasing medication errors. Moreover, these outcomes will fundamentally advance our knowledge and the promotion of medication safety.