Clinical trial NCT00599209: Health Information Technology in the Nursing Home
Official title: Health Information Technology in the Nursing Home
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Patient Safety
Prescribing Practices
Laboratory Monitoring Practices
Lead sponsor: University of Massachusetts, Worcester
Sponsor class: OTHER
Collaborators: name: Baycrest Centre for Geriatric Care
name: Agency for Healthcare Research and Quality (AHRQ)
First posted: 2008-01-23
Enrollment: 23
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: The magnitude and intensity of medication use among our nation's 1.6 million nursing home residents matches or exceeds that of hospitalized patients. The residents of nursing homes are among the most frail patients in the population; the challenges of using medications in this setting are great, not only because of the physiologic declines and pharmacologic changes that occur with aging, but also because of the special clinical and social circumstances that often characterize nursing home care. In our previous research, we have determined that medication errors resulting in adverse drug events occur most often at the ordering and monitoring stages of pharmaceutical care. Clinical decision-support systems are clinical consultation systems that combine individual patient information with population statistics and scientific evidence to offer real-time information to health care providers. These systems have been found to improve the quality of medication prescribing in the hospital setting. In this study, we intend to determine the extent to which a computer-based clinical decision-support system (accompanying computerized provider order-entry) can improve the quality of medication ordering and monitoring for residents in the long-term care setting through a randomized trial. We will track the costs associated with this system and the system's impact on the productivity of providers. We will also assess the culture of U.S. nursing homes and the organization of the nursing home setting with respect to readiness to incorporate computerized provider order-entry with computer-based clinical decision support. Our project addresses specific areas that are of particular interest to AHRQ with special relevance to the delivery of high-quality care to a priority population--the frail elderly patient population residing in nursing homes. The project will assess the economic implications of health information technology in the nursing home environment that will be of interest to key stakeholders, including physicians, pharmacists, nurses, payers, policymakers, the nursing home industry, and pharmaceutical vendors to long-term care institutions.


Eligibility criteria: Inclusion Criteria:

* prescriber at the study facility

Exclusion Criteria:

* not a prescriber at the study facility

Primary outcomes:
measure: extent to which a computer-based clinical decision-support system (accompanying computerized provider order-entry) can improve the quality of medication ordering and monitoring
timeFrame: two years
Secondary outcomes:
measure: costs associated with this system and the system's impact on the productivity of providers
timeFrame: two years
Other outcomes:
Locations:
city: Worcester
country: United States
facility: Meyers Primary Care Institute
state: Massachusetts
Study officials:
affiliation: Meyers Primary Care Institute
name: Jerry H Gurwitz, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Subramanian S, Hoover S, Gilman B, Field TS, Mutter R, Gurwitz JH. Computerized physician order entry with clinical decision support in long-term care facilities: costs and benefits to stakeholders. J Am Geriatr Soc. 2007 Sep;55(9):1451-7. doi: 10.1111/j.1532-5415.2007.01304.x.
citation: Field TS, Rochon P, Lee M, Gavendo L, Baril JL, Gurwitz JH. Computerized clinical decision support during medication ordering for long-term care residents with renal insufficiency. J Am Med Inform Assoc. 2009 Jul-Aug;16(4):480-5. doi: 10.1197/jamia.M2981. Epub 2009 Apr 23.