College of William and Mary, Williamsburg, VA, USA.
Am J Health Syst Pharm. 2010 Apr 15;67(8):613-20. doi: 10.2146/ajhp090056.
The effects of an adverse-drug-event (ADE) alert system on cost and quality outcomes in community hospitals were evaluated.
This retrospective observational study evaluated the effects of an ADE alert system in seven hospitals in the Trinity Health network. Outcomes for all inpatients admitted to these hospitals after and one year before the deployment of an ADE alert system were evaluated. Inpatients in two network hospitals that lacked any computerized ADE alert system constituted the external control group. Administrative data were gathered for patients from these facilities for the same time frames as for the preimplementation and postimplementation groups. Primary outcomes evaluated included pharmacy department costs, variable drug costs, and mortality rates. Secondary outcomes included total hospitalization costs, length of hospital stay (LOS), rate of readmission, and case-mix index. Mean differences in primary and secondary outcome measures across all four groups were examined using analysis of variance.
Significant decreases in mean pharmacy department costs per patient were observed from preimplementation to postimplementation (p < 0.001), while pharmacy department costs increased significantly in the external control group (p = 0.029). Drug costs decreased significantly from baseline (p < 0.001) in the postimplementation group. Drug costs increased significantly in the external control group (p = 0.029). Severity-adjusted mortality rates and LOS decreased significantly in the postimplementation group. Total patient hospitalization costs, both crude and severity adjusted, significantly increased in both groups.
Implementation of an ADE alert system in seven community hospitals demonstrated significant decreases in pharmacy department costs, variable drug costs, and severity-adjusted mortality rates.
评估不良药物事件（ADE）警报系统对社区医院成本和质量结果的影响。
本回顾性观察性研究评估了特利福利健康网络（Trinity Health network）中的七家医院中 ADE 警报系统的效果。评估了在部署 ADE 警报系统后和前一年入住这些医院的所有住院患者的结果。在缺乏任何计算机化 ADE 警报系统的两个网络医院中，住院患者构成外部对照组。为这些设施的患者收集了与预实施和实施后组相同时间段的行政数据。评估的主要结果包括药房部门成本、可变药物成本和死亡率。次要结果包括总住院费用、住院时间（LOS）、再入院率和病例组合指数。使用方差分析检查了所有四个组中主要和次要结果衡量指标的平均值差异。
从预实施到实施后，观察到每个患者的药房部门成本平均值显著降低（p<0.001），而外部对照组的药房部门成本显著增加（p=0.029）。实施后组的药物成本从基线显著降低（p<0.001）。外部对照组的药物成本显著增加（p=0.029）。实施后组的严重程度调整死亡率和 LOS 显著降低。未经调整和严重程度调整的总患者住院费用在两个组中均显著增加。
在七家社区医院实施 ADE 警报系统可显著降低药房部门成本、可变药物成本和严重程度调整死亡率。
