J Am Med Inform Assoc - Automating the medication regimen complexity index.

Tópicos

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Resumo

JECTIVE: To adapt and automate the medication regimen complexity index (MRCI) within the structure of a commercial medication database in the post-acute home care setting.MATERIALS AND METHODS: In phase 1, medication data from 89 645 electronic health records were abstracted to line up with the components of the MRCI: dosage form, dosing frequency, and additional administrative directions. A committee reviewed output to assign index weights and determine necessary adaptations. In phase 2 we examined the face validity of the modified MRCI through analysis of automatic tabulations and descriptive statistics.RESULTS: The mean number of medications per patient record was 7.6 (SD 3.8); mean MRCI score was 16.1 (SD 9.0). The number of medications and MRCI were highly associated, but there was a wide range of MRCI scores for each number of medications. Most patients (55%) were taking only oral medications in tablet/capsule form, although 16% had regimens with three or more medications with different routes/forms. The biggest contributor to the MRCI score was dosing frequency (mean 11.9). Over 36% of patients needed to remember two or more special instructions (eg, take on alternate days, dissolve).DISCUSSION: Medication complexity can be tabulated through an automated process with some adaptation for local organizational systems. The MRCI provides a more nuanced way of measuring and assessing complexity than a simple medication count.CONCLUSIONS: An automated MRCI may help to identify patients who are at higher risk of adverse events, and could potentially be used in research and clinical decision support to improve medication management and patient outcomes.

Resumo Limpo

jectiv adapt autom medic regimen complex index mrci within structur commerci medic databas postacut home care settingmateri method phase medic data electron health record abstract line compon mrci dosag form dose frequenc addit administr direct committe review output assign index weight determin necessari adapt phase examin face valid modifi mrci analysi automat tabul descript statisticsresult mean number medic per patient record sd mean mrci score sd number medic mrci high associ wide rang mrci score number medic patient take oral medic tabletcapsul form although regimen three medic differ routesform biggest contributor mrci score dose frequenc mean patient need rememb two special instruct eg take altern day dissolvediscuss medic complex can tabul autom process adapt local organiz system mrci provid nuanc way measur assess complex simpl medic countconclus autom mrci may help identifi patient higher risk advers event potenti use research clinic decis support improv medic manag patient outcom

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