Lin Ching-Pin, Guirguis-Blake Janelle, Keppel Gina A, Dobie Sharon, Osborn Justin, Cole Allison M, Baldwin Laura-Mae
Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA.
Department of Family Medicine, University of Washington, Seattle, Washington, USA.
J Innov Health Inform. 2016 Apr 15;23(1):450-8. doi: 10.14236/jhi.v23i1.157.
Adverse drug events (ADEs) are a leading cause of death in the United States. Patients with stage 3 and 4 chronic kidney disease (CKD) are at particular risk because many medications are cleared by the kidneys. Alerts in the electronic health record (EHR) about drug appropriateness and dosing at the time of prescription have been shown to reduce ADEs for patients with stage 3 and 4 CKD in inpatient settings, but more research is needed about the implementation and effectiveness of such alerts in outpatient settings.
To explore factors that might inform the implementation of an electronic drug-disease alert for patients with CKD in primary care clinics, using Rogers' diffusion of innovations theory as an analytic framework.
Interviews were conducted with key informants in four diverse clinics using various EHR systems. Interviews were audio recorded and transcribed. results Although all clinics had a current method for calculating glomerular filtration rate (GFR), clinics were heterogeneous with regard to current electronic decision support practices, quality improvement resources, and organizational culture and structure.
Understanding variation in organizational culture and infrastructure across primary care clinics is important in planning implementation of an intervention to reduce ADEs among patients with CKD.
药物不良事件（ADEs）是美国主要的死亡原因之一。3期和4期慢性肾脏病（CKD）患者面临特殊风险，因为许多药物通过肾脏清除。电子健康记录（EHR）中关于处方时药物适宜性和剂量的警示已被证明可降低住院环境中3期和4期CKD患者的ADEs，但对于此类警示在门诊环境中的实施和效果仍需更多研究。
以罗杰斯创新扩散理论为分析框架，探索可能为基层医疗诊所中CKD患者实施电子药物 - 疾病警示提供依据的因素。
对使用各种EHR系统的四家不同诊所的关键信息提供者进行访谈。访谈进行了录音和转录。结果尽管所有诊所都有当前计算肾小球滤过率（GFR）的方法，但各诊所在当前电子决策支持实践、质量改进资源以及组织文化和结构方面存在差异。
了解基层医疗诊所组织文化和基础设施的差异对于规划实施减少CKD患者ADEs的干预措施很重要。
