Harnessing Health IT to Prevent Medication-Induced Birth Defects

利用健康信息技术预防药物引起的出生缺陷

基本信息

批准号：
7359394
负责人：
ELEANOR Bimla SCHWARZ
金额：
$ 39.98万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-09-07 至 2010-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7359394
关键词：
Harnessing Health Prevent Medication Induced

Harnessing Health Prevent Medication Induced

项目摘要

The Institute of Medicine has identified prevention of birth defects as one of six priorities for the nation's health because annually, 150,000 infants (1% - 3% of all U.S. births) are born with some form of physical or mental birth defect. It is estimated that each year, 12 million US women use medications that increase the risk of birth defects. With concurrent use of contraception, birth defects associated with these medications can be prevented. Unfortunately, when prescribing these medications, clinicians rarely counsel women about contraception, and approximately 6% of US pregnancies are exposed to medications that may increase risk of birth defects. As Health IT has improved the safety of medication management in some healthcare settings, we propose to develop and then rigorously evaluate ways computers may be able to help doctors counsel women about preventing birth defects caused by use of certain medications. To better understand what information about risk of medication-induced birth defects would be most useful to primary care clinicians and their patients, we will begin this project by conducting a series of focus groups with clinicians and patients seen in academic and community-based practices. Data from these discussions will help refine the two Health IT interventions we will develop. We will evaluate the impact of each of these interventions using a factorial design randomized controlled trial. In the first trial, we will compare multi-faceted decision support (intervention) to streamlined clinical alerts (control). In the second trial, we will evaluate whether collecting machine-actionable information about women?s risk of pregnancy using a networked tablet computer (intervention) is superior to the way clinicians usually collect this information (control). Over the course of 1 year, we will abstract data from the electronic medical record when study clinicians prescribe teratogenic medications (N=1500), conduct phone interviews with women (N=800) prescribed medications by participating clinicians, and survey participating clinicians (N=100) about their satisfaction with the decision support they receive. We will use this data to confirm our hypotheses that clinicians in the intervention groups will (1) prescribe fewer teratogenic medications, (2) be more likely to prescribe contraception when a teratogenic medication is prescribed, (3) have more patients report satisfaction with the counseling they received, and (4) report more satisfaction with the decision support they received. This evaluation will provide much-needed information on how Health IT can best be harnessed to prevent medication-induced birth defects nationwide. In addition, the Health IT intervention shown to be most effective will be disseminated within the University of Pittsburgh Medical Center, which provides 3 million outpatient visits each year.

医学研究所已确定预防先天缺陷是该国的六个优先事项之一健康，因为每年，有15万名婴儿（占所有美国出生的1％ - 3％）出生于某种形式的身体或精神先天缺陷。据估计，每年有1200万美国妇女使用药物增加风险出生缺陷。通过同时使用避孕药，与这些药物相关的先天缺陷可以是阻止。不幸的是，在开处方这些药物时，临床医生很少向妇女提供有关避孕，大约6％的美国怀孕暴露于可能增加的风险出生缺陷。随着健康状况在某些医疗机构中提高了药物管理的安全性，我们建议开发，然后严格评估计算机可能能够帮助医生咨询妇女的方式关于防止使用某些药物引起的先天缺陷。更好地了解哪些信息关于药物引起的先天缺陷的风险对于初级保健临床医生及其患者，我们将通过与临床医生和患者进行一系列焦点小组开始该项目学术和基于社区的实践。这些讨论中的数据将有助于完善这两个健康状况我们将开发干预措施。我们将使用阶乘评估这些干预措施的影响设计随机对照试验。在第一个试验中，我们将比较多方面的决策支持（干预）简化临床警报（控制）。在第二次试验中，我们将评估是否收集关于女性使用网络平板电脑怀孕风险的机器可笑信息（干预）优于临床医生通常收集此信息的方式（对照）。在1年的过程中，我们将在学习时从电子病历中抽象数据临床医生开出致病药物（n = 1500），对女性进行电话采访（n = 800）通过参与临床医生开出药物，并调查参与的临床医生（n = 100）满足他们获得的决策支持。我们将使用这些数据来确认我们的假设干预组中的临床医生将（1）开出更少的致病药物，（2）更有可能开处方避孕药时，（3）有更多患者报告满意度通过他们收到的咨询，（4）对他们收到的决策支持的满意度更高。该评估将提供急需的信息，以了解如何最好地利用健康状况药物引起的先天缺陷在全国范围内。此外，显示出最有效的健康IT干预措施将在匹兹堡大学医学中心（University of Pittsburgh Medical Center 每年访问。