| Comparison of a basic and an advanced pharmacotherapy-related clinical decision support system in a hospital care setting in the Netherlands. | |
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MedLine Citation:
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PMID: 21890873 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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ObjectiveTo compare the clinical relevance of medication alerts in a basic and in an advanced clinical decision support system (CDSS).DesignA prospective observational study.Materials and methodsWe 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.ResultsThe 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).ConclusionThe 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. |
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Authors:
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Willemijn L Eppenga; Hieronymus J Derijks; Jean M H Conemans; Walter A J J Hermens; Michel Wensing; Peter A G M De Smet |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-9-2 |
Journal Detail:
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Title: Journal of the American Medical Informatics Association : JAMIA Volume: - ISSN: 1527-974X ISO Abbreviation: - Publication Date: 2011 Sep |
Date Detail:
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Created Date: 2011-9-5 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9430800 Medline TA: J Am Med Inform Assoc Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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IQ healthcare, 's-Hertogenbosch, The Netherlands. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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