J Am Med Inform Assoc - Comparison of a basic and an advanced pharmacotherapy-related clinical decision support system in a hospital care setting in the Netherlands.

Tópicos

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Resumo

LABELLED: OBJECTIVE To compare the clinical relevance of medication alerts in a basic and in an advanced clinical decision support system (CDSS).DESIGN: A prospective observational study.MATERIALS AND METHODS: We collected 4023 medication orders in a hospital for independent evaluation in two pharmacotherapy-related decision support systems. Only the more advanced system considered patient characteristics and laboratory test results in its algorithms. Two pharmacists assessed the clinical relevance of the medication alerts produced. The alert was considered relevant if the pharmacist would undertake action (eg, contact the physician or the nurse). The primary analysis concerned the positive predictive value (PPV) for clinically relevant medication alerts in both systems.RESULTS: The PPV was significantly higher in the advanced system (5.8% vs 17.0%; p<0.05). Significant differences were found in the alert categories: drug-(drug) interaction (9.9% vs 14.8%; p<0.05), drug-age interaction (2.9% vs 73.3%; p<0.05), and dosing guidance (5.6% vs 16.9%; p<0.05). Including laboratory values and other patient characteristics resulted in a significantly higher PPV for the advanced CDSS compared to the basic medication alerts (12.2% vs 23.3%; p<0.05).CONCLUSION: The advanced CDSS produced a higher proportion of clinically relevant medication alerts, but the number of irrelevant alerts remained high. To improve the PPV of the advanced CDSS, the algorithms should be optimized by identifying additional risk modifiers and more data should be made electronically available to improve the performance of the algorithms. Our study illustrates and corroborates the need for cyclic testing of technical improvements in information technology in circumstances representative of daily clinical practice.

Resumo Limpo

label object compar clinic relev medic alert basic advanc clinic decis support system cdssdesign prospect observ studymateri method collect medic order hospit independ evalu two pharmacotherapyrel decis support system advanc system consid patient characterist laboratori test result algorithm two pharmacist assess clinic relev medic alert produc alert consid relev pharmacist undertak action eg contact physician nurs primari analysi concern posit predict valu ppv clinic relev medic alert systemsresult ppv signific higher advanc system vs p signific differ found alert categori drugdrug interact vs p drugag interact vs p dose guidanc vs p includ laboratori valu patient characterist result signific higher ppv advanc cdss compar basic medic alert vs pconclus advanc cdss produc higher proport clinic relev medic alert number irrelev alert remain high improv ppv advanc cdss algorithm optim identifi addit risk modifi data made electron avail improv perform algorithm studi illustr corrobor need cyclic test technic improv inform technolog circumst repres daili clinic practic

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