Improving Laboratory Monitoring in Community Practices: A Randomized Trial

改善社区实践中的实验室监测：随机试验

• 批准号: 8175572
• 负责人: STEVEN R. SIMON
• 金额: $ 12.31万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-01 至 2012-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8175572
• 关键词: Improving; Laboratory; Monitoring; Community; Practices

DESCRIPTION (provided by the applicant): Medication errors and preventable adverse drug events occur commonly among patients in the ambulatory setting and constitute an important target for patient safety and quality improvement. Laboratory monitoring to ensure the safety and effectiveness of drug therapy and the timely management of abnormal results of laboratory testing have been increasingly recognized as important areas for improving patient safety in ambulatory care. Promising interventions have been developed for practices affiliated with hospitals and integrated delivery systems, but efforts to date have not adequately reached physicians practicing solo or in small practices in the community. The Massachusetts e-Health Collaborative (MAeHC; www.maehc.org) provides an important opportunity to study implementation of healthcare information technology innovations in a community setting. In 2007, the MAeHC will complete the implementation of commercially available electronic health records (EHRs) for 441 physicians in more than 200 office practices in three diverse communities in Massachusetts. In this group of small-to-medium sized office practices in both urban and rural regions of the State, we propose a cluster-randomized controlled trial (RCT) of computerized point-of-care alerts in the EHR to prevent errors related to laboratory monitoring at the initiation and continuation of drug therapy and a results management system to prevent errors related to the delay in follow-up of abnormal laboratory testing. We will: 1) identify the barriers to and facilitators of laboratory monitoring and timely follow- up of abnormal laboratory results, especially for elderly patients and clinical scenarios common to this population; 2) design, implement and evaluate the effectiveness of clinical decision support (point-of-care alerts) for laboratory monitoring in a widely used, commercially available EHR; 3) design, implement and evaluate the effectiveness of a results management system to improve the timely follow-up of abnormal laboratory test results in office practice; 4) develop a practical dissemination guide to assist other practices and communities interested in implementing similar interventions. The results of this study will be important because they will demonstrate and accelerate the dissemination of clinicians' use of healthcare information technology to improve patient safety and healthcare quality beyond integrated delivery systems and should be broadly generalizable to small- and medium-sized office practices in community settings. 1 Improving Laboratory Monitoring in Community Practices: A Randomized Trial. Medication errors occur frequently among patients in the ambulatory setting and cause many preventable adverse drug events; thus, they constitute an important target for patient safety and quality improvement. We propose a community-based randomized controlled trial of clinical-decision support to improve laboratory monitoring of medication use and a results management program to improve the timely follow-up of abnormal laboratory tests. This practical clinical trial will evaluate the effectiveness of promoting clinicians' use of commercially available healthcare information technology to improve medication safety in the ambulatory care setting.

描述（由申请人提供）：在门诊环境中，患者通常发生药物错误和可预防的不良药物事件，构成了患者安全和质量改善的重要目标。实验室监测以确保药物治疗的安全性和有效性以及实验室测试异常结果的及时管理已被越来越多地被认为是改善病人安全护理中患者安全的重要领域。已经开发了有希望的干预措施，用于隶属医院和综合送货系统的实践，但是迄今为止的努力尚未充分接触到独奏或社区中的小型实践的医生。马萨诸塞州电子卫生合作（MAEHC; www.maehc.org）提供了一个重要的机会，可以在社区环境中研究医疗保健信息技术创新的实施。 2007年，MAEHC将完成马萨诸塞州三个不同社区的200多个办公惯例的441位医生的市售电子健康记录（EHRS）的实施。在该州城市和农村地区的这组小型到中等大小的办公室实践中，我们提出了EHR中计算机化点的护理警报的群集随机对照试验（RCT），以防止与实验室监测相关的错误，以防止药物治疗和结果管理系统的延续与实验性测试相关的错误。我们将：1）确定实验室监测的障碍和促进者，并及时跟进异常的实验室结果，尤其是对于老年患者和该人群常见的临床情况； 2）设计，实施和评估临床决策支持（护理点警报）的有效性，以在广泛使用的，可商购的EHR中进行实验室监测； 3）设计，实施和评估结果管理系统的有效性，以改善办公实践中异常实验室测试结果的及时随访； 4）制定实用传播指南，以帮助有兴趣实施类似干预措施的其他实践和社区。这项研究的结果将很重要，因为它们将证明和加速临床医生对医疗保健信息技术的传播，以提高综合交付系统以外的患者安全和医疗保健质量，并且应该广泛推广到社区环境中的中小型办公室实践。 1改进社区实践中的实验室监测：一项随机试验。在门诊环境中，患者经常发生用药错误，并引起许多可预防的不良药物事件。因此，它们构成了患者安全和质量改善的重要目标。我们提出了一项基于社区的临床决策支持的随机对照试验，以改善对药物使用的实验室监测和结果管理计划，以改善异常实验室测试的及时随访。这项实用的临床试验将评估促进临床医生使用市售医疗信息技术以改善门诊护理环境中的药物安全的有效性。