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IAB 05-224 – HSR&D Study

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IAB 05-224
Implementation of Real-Time ADE Surveillance and Decision Support
Jonathan R. Nebeker MD MS
VA Salt Lake City Health Care System, Salt Lake City, UT
Salt Lake City, UT
Funding Period: April 2007 - September 2010

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 study, in two parts, of computerized real-time ADE alerts intended for primary and secondary prevention of ADEs. At Salt Lake City, we are conducting a pseudo-randomized controlled trial in which 50% of the patients' records will be randomized to be eligible to produce ADE 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:
From September 2009 to September 2010, there were 573 potential adverse drug events with a trigger condition identified, 291 in the control and 282 in the intervention group. These triggers alerted potential adverse drug events for 394 unique patients.

IMPACT:
The ADE alerts promise to reduce mortality, morbidity, and costs due to ADEs.

Remaining analyses will quantify the effect of the alerts in the hands of VA medical residents (including, but not limited to, first-year residents); explore the associations of organizational and socio-cognitive barriers and facilitators with the adoption of the ADE alert technology; and explore whether ADE alerts change user bias in diagnosing ADEs or whether the alerts heighten sensitivity to drug problems.


PUBLICATIONS:

Journal Articles

  1. Walsh JA, Shao Y, Leng J, He T, Teng CC, Redd D, Treitler Zeng Q, Burningham Z, Clegg DO, Sauer BC. Identifying Axial Spondyloarthritis in Electronic Medical Records of US Veterans. Arthritis care & research. 2017 Sep 1; 69(9):1414-1420.
  2. Olola CH, Rowan B, Narus S, Smith M, Hastings T, Poynton M, Nebeker J, Hales J, Evans RS. Implementation of an emergency medical card and a continuity of care. Methods of Information in Medicine. 2011 Jun 28; 48(6):519-30.
  3. LaFleur J, McAdam-Marx C, Alder SS, Sheng X, Asche CV, Nebeker J, Brixner DI, Silverman SL. Clinical risk factors for fracture among postmenopausal patients at risk for fracture: a historical cohort study using electronic medical record data. Journal of Bone and Mineral Metabolism. 2011 Mar 1; 29(2):193-200.
  4. Boockvar KS, Livote EE, Goldstein N, Nebeker JR, Siu A, Fried T. Electronic health records and adverse drug events after patient transfer. Quality & Safety in Health Care. 2010 Oct 1; 19(5):e16.
  5. Kaafarani HM, Rosen AK, Nebeker JR, Shimada S, Mull HJ, Rivard PE, Savitz L, Helwig A, Shin MH, Itani KM. Development of trigger tools for surveillance of adverse events in ambulatory surgery. Quality & Safety in Health Care. 2010 Oct 1; 19(5):425-9.
  6. Weir CR, Nebeker JR. Critical issues in an electronic documentation system. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 2007 Oct 11; 786-90.
  7. 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 Oct 1; 45(10 Supl 2):S81-8.
  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 Oct 1; 45(10 Supl 2):S77-80.
Center Products

  1. Rupper RW. Cover to Cover. 2016 Oct 1. Available from: http://www.longtermscorecard.org/~/media/Microsite/Files/2017/2017%20Scorecard/Veterans/AARP1195_PP_NWDandVeterans_WEB.PDF.
Conference Presentations

  1. Sauer BC, Nebeker JR, Shen S, Rupper RW, Samore MH. Identification of possible adverse drug reactions using population based administrative data. Presented at: Patient Safety Research Annual Conference; 2014 Mar 25; Ubon, Thailand.
  2. Kaafarani H, Rosen AK, Nebeker JR, Shimada S, Mull H, Rivard PE, Long B, Savitz L, Helwig A, Itani K. Developing Trigger Tools for Surveillance of Adverse Events in Same-Day Surgery: A Literature-based, end-user inspired and expert-evaluated methodology. Poster session presented at: Agency for Healthcare Research and Quality Annual Conference; 2009 Sep 13; Rockville, MD.
  3. Boockvar KC, Siu, Goldstein, Nebeker, Fried. Risk of Harm from Prescribing Discrepancies at the Time of Nursing Home-Hospital Transfer with and without a shared, across-site, electronic prescribing system. Presented at: AcademyHealth Annual Research Meeting; 2008 Jun 8; Washington, DC.
  4. LaFleur, Pickard, Nebeker. Recognition and treatment of osteoporosis is low in at least one VISN. Presented at: VA HSR&D National Meeting; 2008 Feb 1; Baltimore, MD.
  5. Nebeker, Weir, Hicken, Sauer. Barriers to the Adoption of VA Care Management Software. Presented at: VA HSR&D National Meeting; 2007 Feb 21; Arlington, VA.
  6. Nebeker, Yarnold, Soltysik, Sauer, Xu. Developing Indicators of Adverse Drug Events via Non-Linear Analysis of Administrative Data. Presented at: VA HSR&D National Meeting; 2007 Feb 21; Arlington, VA.
  7. Sauer, Nebeker, Rupper, Samore. Serum Potassium Monitoring and Hyperkalemia in Veterans using Renin-Angiotensin-Aldosterone Inhibitors. Presented at: VA HSR&D National Meeting; 2007 Feb 21; Arlington, VA.


DRA: Health Systems
DRE: none
Keywords: Adverse Event Monitoring, Adverse events, Decision Support, Informatics, Quality assurance, improvement, Safety
MeSH Terms: none

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