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.
調査の概要
研究の種類
入学 (実際)
段階
- 適用できない
連絡先と場所
研究場所
-
-
Massachusetts
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Springfield、Massachusetts、アメリカ、01199
- Baystate Medical Center
-
-
参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- Hospitalized patients with Age > 65
Exclusion Criteria:
- None
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:防止
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:独身
武器と介入
参加者グループ / アーム |
介入・治療 |
---|---|
介入なし:普段のお手入れ
|
|
実験的: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.
|
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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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
時間枠 |
---|---|
The percentage of elderly patients who receive a specified high-risk medication from the Beer's list.
時間枠:Earlier of hospital stay or end of study
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Earlier of hospital stay or end of study
|
二次結果の測定
結果測定 |
時間枠 |
---|---|
The average number of specified high risk medications prescribed per patient.
時間枠:Earlier of hospital stay or end of study
|
Earlier of hospital stay or end of study
|
Restraint use
時間枠:Earlier of hospital stay or end of study
|
Earlier of hospital stay or end of study
|
Falls
時間枠:Earlier of hospital stay or end of study
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Earlier of hospital stay or end of study
|
Length of stay
時間枠:Earlier of hospital stay or end of study
|
Earlier of hospital stay or end of study
|
Total Cost
時間枠:Earlier of hospital stay or end of study
|
Earlier of hospital stay or end of study
|
Discharge status
時間枠:6 months
|
6 months
|
協力者と研究者
スポンサー
捜査官
- 主任研究者:Linda J Canty, MD、Baystate Medical Center
研究記録日
主要日程の研究
研究開始
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (見積もり)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
その他の研究ID番号
- 132454
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。
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