- ICH GCP
- US Clinical Trials Registry
- Klinisk forsøg NCT01034761
Using Clinical Alerts to Decrease Inappropriate Medication Prescribing
Using Clinical Alerts in a Computerized Provider Order Entry System to Decrease Inappropriate Medication Prescribing Among Hospitalized Elders
Introduction:
The Beers list identifies medications that should be avoided in persons 65 years or older because they are ineffective, pose an unnecessarily high risk, or a safer alternative is available. In a recent study, we found a high rate of prescribing of Beers list medications to hospitalized patients. At Baystate, 41% of medical patients received at least one Beers list drug classified as "high severity," meaning it carried a high risk for an adverse drug reaction, while 5% received 3 or more. Some Beers drugs have been associated with delirium and falls. When compared to Baystate patients who did not receive a high severity medication, those who did had an increased risk of mortality (7.8% vs. 5.2%), longer length of stay (5.5 days vs. 3.9 days) and higher costs ($11,240 vs. 6243).
Specific Aims:
- Quantify the impact of synchronous electronic alerts on physician prescribing of high-severity Beers' list drugs to hospitalized patients over the age of 65 years.
- Compare physician reactions to each drug-specific alert
Project Description:
We will develop a series of clinical alerts in CIS, Baystate's computerized provider order entry system, to reduce the use of potentially inappropriate medications among hospitalized elders. We will randomize providers to electronic alerts or usual care. Whenever a provider randomized to alerts attempts to place an order for a high-risk medication on the Beers list and the intended recipient is over 65 years of age, a synchronous alert (i.e. a "pop-up") will inform the physician about the risks associated with the medication and will propose safer alternatives.
We will collect data on physician ordering and patient outcomes comparing the number of Beers list prescriptions from providers receiving electronic alerts to those not receiving alerts. Our anticipated outcome is a decrease in inappropriate prescribing during the period when the electronic alerts are activated. Other potential outcomes include decrease in length of stay and a decrease in falls.
Studieoversigt
Undersøgelsestype
Tilmelding (Faktiske)
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiesteder
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Massachusetts
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Springfield, Massachusetts, Forenede Stater, 01199
- Baystate Medical Center
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Deltagelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- Hospitalized patients with Age > 65
Exclusion Criteria:
- None
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Forebyggelse
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Enkelt
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
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Ingen indgriben: Sædvanlig pleje
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Eksperimentel: Pop-up alerts
Providers will receive pop-up alerts in the electronic medical record when prescribing one of the specified medications from the Beers list.
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Pop-up alert in the electronic medical record whenever the provider enters an order for a specified high risk medication from the Beers list.
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Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Tidsramme |
---|---|
The percentage of elderly patients who receive a specified high-risk medication from the Beer's list.
Tidsramme: Earlier of hospital stay or end of study
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Earlier of hospital stay or end of study
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Sekundære resultatmål
Resultatmål |
Tidsramme |
---|---|
The average number of specified high risk medications prescribed per patient.
Tidsramme: Earlier of hospital stay or end of study
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Earlier of hospital stay or end of study
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Restraint use
Tidsramme: Earlier of hospital stay or end of study
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Earlier of hospital stay or end of study
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Falls
Tidsramme: Earlier of hospital stay or end of study
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Earlier of hospital stay or end of study
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Length of stay
Tidsramme: Earlier of hospital stay or end of study
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Earlier of hospital stay or end of study
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Total Cost
Tidsramme: Earlier of hospital stay or end of study
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Earlier of hospital stay or end of study
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Discharge status
Tidsramme: 6 months
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6 months
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Samarbejdspartnere og efterforskere
Sponsor
Efterforskere
- Ledende efterforsker: Linda J Canty, MD, Baystate Medical Center
Datoer for undersøgelser
Studer store datoer
Studiestart
Primær færdiggørelse (Faktiske)
Studieafslutning (Faktiske)
Datoer for studieregistrering
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først opslået (Skøn)
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Skøn)
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Andre undersøgelses-id-numre
- 132454
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