Evaluating the Impact of an ACPOE/CDS System on Outcomes

评估 ACPOE/CDS 系统对结果的影响

• 批准号: 6951227
• 负责人: SEAN D SULLIVAN
• 金额: $ 33.75万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-30 至 2007-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6951227
• 关键词: behavioral /social science research tag; biomedical automation; clinical research; community health services; computer assisted medical decision making; computer human interaction; computer network; cooperative study; epidemiology; family medicine; focus groups; health care facility; health care personnel; health care quality; health care service organization; health services research tag; human subject; interview; longitudinal human study; outcomes research; outpatient care; patient safety /medical error; pediatrics; primary care physician; questionnaires

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.

描述（由申请人提供）：医学研究所的最新出版物将全国关注放在患者安全问题上，并建议信息技术可以通过减少错误和创造组织效率来提高患者安全的潜力。医疗保健研究和质量机构建议，作为提高患者安全性的策略，具有内置临床决策支持（CDS）的计算机化处方者订单（CPOE）系统的实施。迄今为止，该建议的策略已被实施和评估，主要是在住院和学术：环境中；在基于社区的综合健康系统的门诊环境中，较少的频率。该项目的主要目标是在门诊，基于社区的综合健康系统中实施具有CDS功能的CPOE系统，并评估系统内部，组织过程和人为因素的影响；在外部，根据用药错误和不良药物事件来衡量的患者安全。这个为期三年的项目有两个具体的目标。 AIM 1是在Everett Clinic的所有13个地点实施ABRUTONATY CPOE/ CDS系统，Everett Clinic是一个基于社区的综合健康系统。我们将记录学习的经验教训，并评估系统对组织工作量过程以及使用该系统的卫生专业人员的行为的影响。在AIM 2中，我们将通过表征在实施前后的药物错误的流行病学来评估卧床CPOE/ CDS系统对患者安全的影响；并将这些错误与不利事件联系起来。虽然该实施将在所有13个地点进行，但评估的一部分将在家庭诊所和儿科诊所进行，两家匹配的诊所用作对照组。在AIM 1中，将记录用于实现成功的策略和经验教训。将使用回顾性报告机制和时间和运动分析来捕获工作量指标。信息技术与人为因素之间的关系将通过线人访谈，焦点小组以及对卫生专业人员的调查工具的管理来捕获。在AIM 2中，将回顾性评估10,000个处方，以使用定义的定义和严重性水平来识别和表征药物错误和潜在错误。错误将与导致急诊室或住院的不良事件有关。所有评估将比较数据前到实施后的数据。由此产生的手稿将集中在概括性上，以便外部利益相关者可以从我们的工作中受益。这将是第一个项目之一，将评估CPOE/CDS系统在基于门诊的社区环境中的实施，并以结构化和系统的方式进行结果。