Division of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri 64108, USA.
Appl Clin Inform. 2012 May 16;3(2):186-96. doi: 10.4338/ACI-2011-11-RA-0068. Print 2012.
Electronic health record systems used in conjunction with clinical decision support (CDS) or computerized provider order entry (CPOE) have shown potential in improving quality of care, yet less is known about the effects of combination use of CDS and CPOE on prescribing rates at discharge.
This study investigates the effectiveness of combination use of CDS and CPOE on appropriate drug prescribing rates at discharge for AMI or HF patients.
Combination use of CDS and CPOE is defined as hospitals self-reporting full implementation across all hospital units of CDS reminders, CDS guidelines, and CPOE. Appropriate prescribing rates of aspirin, ACEI/ARBs, or beta blockers are defined using quality measures from Hospital Compare. Multivariate linear regressions are used to test for differences in mean appropriate prescribing rates between hospitals reporting combination use of CDS and CPOE, compared to those reporting the singular use of one or the other, or the absence of both. Covariates include hospital size, region, and ownership status.
Approximately 10% of the sample reported full implementation of both CDS and CPOE, while 7% and 17% reported full use of only CPOE or only CDS, respectively. Hospitals reporting full use of CDS only reported between 0.2% (95% CI 0.04 - 1.0) and 1.6% (95% CI 0.6 - 2.6) higher appropriate prescribing rates compared to hospitals reporting use of neither system. Rates of prescribing by hospitals reporting full use of both CPOE and CDS did not significantly differ from the control group.
Although associations found between full implementation of CDS and appropriate prescribing rates suggest that clinical decision tools are sufficient compared to basic EHR systems in improving prescribing at discharge, the modest differences raise doubt about the clinical relevance of the findings. Future studies need to continue investigating the causal nature and clinical relevance of these associations.
与临床决策支持（CDS）或计算机化医嘱输入（CPOE）结合使用的电子健康记录系统在提高医疗质量方面显示出了潜力，但对于 CDS 和 CPOE 的联合使用对出院时处方率的影响知之甚少。
本研究旨在调查 CDS 和 CPOE 的联合使用对 AMI 或 HF 患者出院时适当药物处方率的效果。
CDS 和 CPOE 的联合使用定义为医院报告在所有医院单元中全面实施 CDS 提醒、CDS 指南和 CPOE。阿司匹林、ACEI/ARB 或β受体阻滞剂的适当处方率使用 Hospital Compare 的质量指标来定义。使用多变量线性回归测试报告 CDS 和 CPOE 联合使用的医院与报告单独使用一种或两种系统或两种系统均未使用的医院之间适当处方率的平均差异。协变量包括医院规模、地区和所有权状况。
大约 10%的样本报告了 CDS 和 CPOE 的全面实施，而 7%和 17%分别报告了仅 CPOE 或仅 CDS 的全面使用。仅报告 CDS 全面使用的医院报告的适当处方率比未报告使用任何系统的医院高 0.2%（95%CI 0.04-1.0）至 1.6%（95%CI 0.6-2.6）。报告全面使用 CPOE 和 CDS 的医院的处方率与对照组没有显著差异。
尽管 CDS 全面实施与适当处方率之间的关联表明，与基本的 EHR 系统相比，临床决策工具在改善出院时的处方方面已经足够，但这些适度的差异使人们对这些发现的临床意义产生了怀疑。未来的研究需要继续调查这些关联的因果性质和临床意义。
