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Development and impact of computeriz...

Buck, Michael D.

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Development and impact of computerized clinical decision support alerts on prescribing for elderly outpatients.

紀錄類型:	書目-語言資料,印刷品 : Monograph/item
正題名/作者:	Development and impact of computerized clinical decision support alerts on prescribing for elderly outpatients./
作者:	Buck, Michael D.
面頁冊數:	162 p.
附註:	Source: Dissertation Abstracts International, Volume: 68-12, Section: B, page: 7921.
Contained By:	Dissertation Abstracts International68-12B.
標題:	Health Sciences, Health Care Management. -
電子資源:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3294394
ISBN:	9780549395133

Development and impact of computerized clinical decision support alerts on prescribing for elderly outpatients.
Buck, Michael D.

Development and impact of computerized clinical decision support alerts on prescribing for elderly outpatients. - 162 p.

Source: Dissertation Abstracts International, Volume: 68-12, Section: B, page: 7921.

Thesis (Ph.D.)--The University of Utah, 2008.

For over a decade, the prevalence of potentially inappropriate medication (PIM) use as defined by expert consensus recommendations (Beers criteria) in the outpatient elderly population has been between 21.3% and 28.8%. Many interventions have been attempted including government legislation, drug utilization reviews, and physician education with limited success. The purpose of this dissertation is to study the effects of clinical decision support (CDS) alerts embedded within a computerized provider order entry (CPOE) system on PIM prescribing for the elderly outpatient population.

ISBN: 9780549395133Subjects--Topical Terms:

1017922
Health Sciences, Health Care Management.

Development and impact of computerized clinical decision support alerts on prescribing for elderly outpatients.
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502 $a Thesis (Ph.D.)--The University of Utah, 2008.
520 $a For over a decade, the prevalence of potentially inappropriate medication (PIM) use as defined by expert consensus recommendations (Beers criteria) in the outpatient elderly population has been between 21.3% and 28.8%. Many interventions have been attempted including government legislation, drug utilization reviews, and physician education with limited success. The purpose of this dissertation is to study the effects of clinical decision support (CDS) alerts embedded within a computerized provider order entry (CPOE) system on PIM prescribing for the elderly outpatient population.
520 $a Using CPOE medication lists, the measured prevalence of PIMs as of April 1, 2006 was 23.3% (8,693/37,247) of patients at Intermountain Healthcare and 23.0% (5,528/24,004) at the Cleveland Clinic. Patient characteristics associated with PIMs were polypharmacy, female sex and multiple primary care visits. Eight of the top 10 PIMs were the same at both centers.
520 $a A CDS system of geriatric precaution alerts was integrated into Intermountain Healthcare's web-based HELP2 CPOE system. Medication orders entered by clinical users were screened against a geriatric alert knowledgebase with coded content provided by a commercial vendor. Alternative medication suggestions as well as links to external information resources were provided through Infobutton-linked monographs. Clinical input was obtained throughout system development. After 9 months of use, 139,857 medication orders were screened for 29,000 elderly patients resulting in 10,822 total alerts for 7,121 patients. A total of 609 clinicians had alerted orders at 115 facilities.
520 $a A 9-month prospective, randomized controlled trial of the geriatric precaution alerts was conducted in 52 outpatient primary care and specialty clinics. Intervention clinics received the alerts for elderly patients on orders for 86 PIMs, while control clinics received usual care. No significant difference in canceled PIM prescriptions was found between intervention clinics at 4.7% (187/3977) and control clinics at 4.8% (113/2364). None of the individual 86 PIM alerts showed significant differences. Positive physician feedback and high voluntary system activation rates suggest the alerts have some clinical value. Future plans include upgrades to the CPOE alerting interface and the establishment of a CDS review committee.
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