Improving Safety and Quality With Outpatient Order Entry

NCT00243334 | Unknown

• 1 other identifier: 5R01HS015226-02
• Study Type: interventional
• Target: 800
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of this study is to evaluate the impact of integrating ambulatory computerized physician order entry (ACPOE) and advanced clinical decision support systems (CDSS) on safety and quality domains in the ambulatory setting, including: a) medication monitoring, b) preventive care and chronic disease management, and c) test result follow-up. In addition we will evaluate the impact on organizational efficiency, physician workflow and satisfaction, and perform a cost-benefit analysis. We hypothesize that the value of ACPOE integrated with advanced CSDSS lies in improved medication safety and guideline compliance, but also improved efficiencies for the provider and the health-care system.

Conditions

Ambulatory Care Information Systems; Clinical Decision Support Systems

Keywords

Ambulatory Care Information Systems; Clinical Decision Support Systems; Medication Systems; Medication Errors; Reminder Systems; Drug Monitoring; Preventive Health Services; Time and Motion Studies; Efficiency; Cost-Benefit Analysis

Outcome Measures

Primary Outcomes (3)

• Whether an instance that requires ordering of an appropriate laboratory test or medication or other appropriate monitoring action (based on guidelines and electronic clinical data) is associated with appr opriate action.

  Within 14 days of a patient visit or 28 days of the arrival of a test result

• Whether the incidence of a particular abnormal result (based on guidelines and electronic clinical data) was associated with the appropriate follow-up.

  Varies by major test type

• Whether a test ordered does not get performed.

  Varies by major test type

Secondary Outcomes (3)

• The time to appropriate action following the firing of a reminder.

  Within 14 days of the reminder firing

• The time to appropriate monitoring action following the arrival of the index lab result.

  Within 28 days of lab result

• The time to appropriate follow-up following a particular abnormal result.

  Within 28 days of the result

Study Arms (2)

1

EXPERIMENTAL

Decision Support integrated with Order Entry

Other: Integration of advanced clinical decision support with ambulatory computerized physician order entry

2

NO INTERVENTION

Decision Support Only (not integrated with order entry)

Interventions

Integration of advanced clinical decision support with ambulatory computerized physician order entry OTHER

Actiobable Reminders related to medication monitoring, preventive care and chronic disease management, and test result follow-up are administered either during the visit or between visits.

1

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• All physicians in on-site and satellite adult outpatient clinics with the Brigham and Women's Hospital and Massachusetts General Hospital

You may not qualify if:

• Study clinics must have adopted our electronic health record system, the Longitudinal Medical Record, for at least 24 months and must have implemented the basic version of the internally-developed lab order entry module.

Sponsors & Collaborators

• Brigham and Women's Hospital: lead

Study Sites (1)

Partners HealthCare System, Inc.

Boston, Massachusetts, 02481, United States

Location

Study Officials

• Tejal K Gandhi, MD, MPH

  Brigham and Women's Hospital

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Study Record Dates

• First Submitted: October 21, 2005
• First Posted: October 24, 2005
• Study Start: July 1, 2007
• Primary Completion: December 1, 2009
• Study Completion: June 1, 2013
• Last Updated: February 18, 2013

Record last verified: 2013-02

Locations

US (1)