Health Information Technology in the Nursing Home

NCT ID: NCT00599209

Last Updated: 2011-08-04

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 23 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2004-09-30
• Study Completion Date: 2008-09-30

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.

Conditions

Patient Safety; Prescribing Practices; Laboratory Monitoring Practices

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: NONE

Study Groups

A - coded unit ID

Nursing home units provided the CDS intervention

Group Type: EXPERIMENTAL

clinical decision support

Intervention Type: OTHER

CDS is provided to prescribers on intervention units upon ordering medication which offers advice on prescribing and monitoring practices

B - coded unit ID

Nursing home units not provided the CDS intervention

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

clinical decision support

CDS is provided to prescribers on intervention units upon ordering medication which offers advice on prescribing and monitoring practices

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• prescriber at the study facility

Exclusion Criteria

• not a prescriber at the study facility

• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Baycrest Centre for Geriatric Care

OTHER

Sponsor Role: collaborator

Agency for Healthcare Research and Quality (AHRQ)

FED

Sponsor Role: collaborator

University of Massachusetts, Worcester

OTHER

Sponsor Role: lead

Responsible Party

Meyers Primary Care Institute/University of Massachusetts Medical School

Principal Investigators

Jerry H Gurwitz, MD

Role: PRINCIPAL_INVESTIGATOR

Meyers Primary Care Institute

Locations

Meyers Primary Care Institute

Worcester, Massachusetts, United States

Countries

United States

References

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.

Reference Type: BACKGROUND

PMID: 17915344 (View on PubMed)

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.

Reference Type: DERIVED

PMID: 19390107 (View on PubMed)

Other Identifiers

5R01HS015430

Identifier Type: AHRQ

Identifier Source: secondary_id

View Link

11390

Identifier Type: -

Identifier Source: org_study_id