BACKGROUND/RATIONALE:
Inpatient adverse drug events (ADEs) continue to be a major source of morbidity and mortality despite advances in computerized drug safety measures. Reports on the ability of computerized ADE alerts to prevent and mitigate ADEs are lacking.
OBJECTIVE(S):
The aims of this project are to:
1. Assess organizational, social, and cognitive factors that affect adoption of a real-time ADE alerting technology.
2. Analyze the effect of the ADE alerting technology on management and rate of ADEs.
3. Estimate the cost-benefit of the ADE alerting technology.
METHODS:
This is a cluster-randomized study of computerized real-time ADE alerts intended for primary and secondary prevention of ADEs. First-year residents will be randomized on each monthly rotation to have access to the alerts. Clinical pharmacists will also have access to the alerts. Theoretical perspectives at the organizational, social, and cognitive levels frame the design and analysis; they include the IT Implementation Framework, the Theory of Planned Behavior, and signal detection theory.
Difference in rates of usage, ADEs, and recognition of ADEs will be modeled using multi-level Poisson regression. Differences in time to intervention in events will be analyzed using multi-level accelerated failure parametric survival model with shared frailty. The cost-benefit of the ADE alerts will be modeled with multivariate linear regression. Data from the electronic medical record, chart review, surveys, work logs, and case studies inform the analysis.
FINDINGS/RESULTS:
None to date
IMPACT:
The ADE alerts promise to reduce mortality, morbidity, and costs due to ADEs. This study will quantify the effect of the alerts in the hands of first-year medical residents and pharmacists. The study will explore the associations of organizational and socio-cognitive barriers and facilitators with the adoption of the ADE alert technology. At the cognitive level, it will explore whether ADE change user bias in diagnosing ADEs or whether the alerts heighten sensitivity to drug problems.
The dissemination plan provides for widespread dissemination of the practical and theoretical findings throughout the VA and the private healthcare sector.
PUBLICATIONS:
Journal Articles
- Nebeker JR, Yarnold PR, Soltysik RC, Sauer BC, Sims SA, Samore MH, Rupper RW, Swanson KM, Savitz LA, Shinogle J, Xu W. Developing indicators of inpatient adverse drug events through nonlinear analysis using administrative data. Medical Care. 2007; 45(10 Supl 2): S81-8.
- Rupper RW, Bair BD, Sauer BC, Nebeker JR, Shinogle J, Samore M. Out-of-pocket pharmacy expenditures for veterans under Medicare Part D. Medical Care. 2007; 45(10 Supl 2): S77-80.
