Smith Kenneth J, Handler Steven M, Kapoor Wishwa N, Martich G Daniel, Reddy Vivek K, Clark Sunday
University of Pittsburgh, Pittsburgh, PA
University of Pittsburgh, Pittsburgh, PA.
Am J Med Qual. 2016 Jul;31(4):315-22. doi: 10.1177/1062860615574327. Epub 2015 Mar 9.
This study sought to determine the effects of automated primary care physician (PCP) communication and patient safety tools, including computerized discharge medication reconciliation, on discharge medication errors and posthospitalization patient outcomes, using a pre-post quasi-experimental study design, in hospitalized medical patients with ≥2 comorbidities and ≥5 chronic medications, at a single center. The primary outcome was discharge medication errors, compared before and after rollout of these tools. Secondary outcomes were 30-day rehospitalization, emergency department visit, and PCP follow-up visit rates. This study found that discharge medication errors were lower post intervention (odds ratio = 0.57; 95% confidence interval = 0.44-0.74; P < .001). Clinically important errors, with the potential for serious or life-threatening harm, and 30-day patient outcomes were not significantly different between study periods. Thus, automated health system-based communication and patient safety tools, including computerized discharge medication reconciliation, decreased hospital discharge medication errors in medically complex patients.
本研究旨在采用前后对照的准实验研究设计,在一家单一中心,对患有≥2种合并症且服用≥5种慢性药物的住院内科患者,确定自动化初级保健医生(PCP)沟通及患者安全工具(包括计算机化出院用药核对)对出院用药错误及出院后患者结局的影响。主要结局是在这些工具推出前后对比出院用药错误情况。次要结局是30天再住院率、急诊就诊率及PCP随访就诊率。本研究发现,干预后出院用药错误有所减少(优势比=0.57;95%置信区间=0.44 - 0.74;P <.001)。在研究期间,具有严重或危及生命伤害潜在风险的临床重要错误及30天患者结局并无显著差异。因此,基于自动化健康系统的沟通及患者安全工具,包括计算机化出院用药核对,可减少病情复杂内科患者的出院用药错误。