Lipscomb University College of Pharmacy and Health Sciences, Nashville, Tennessee, United States.
HealthIT, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
Appl Clin Inform. 2020 Oct;11(5):865-872. doi: 10.1055/s-0040-1721398. Epub 2020 Dec 30.
The American Geriatrics Society recommends against the use of certain potentially inappropriate medications (PIMs) in older adults. Prescribing of these medications correlates with higher rates of hospital readmissions, morbidity, and mortality. Vanderbilt University Medical Center previously deployed clinical decision support (CDS) to decrease PIM prescribing rates, but recently transitioned to a new electronic health record (EHR).
The goal of this study was to evaluate PIM prescribing rates for older adults before and after migration to the new EHR system.
We reviewed prescribing rates of PIMs in adults 65 years and older, normalized per 100 total prescriptions from the legacy and new EHR systems between July 1, 2014 and December 31, 2019. The PIM prescribing rates before and after EHR migration during November 2017 were compared using a U-chart and Poisson regression model. Secondary analysis descriptively evaluated the frequency of prescriber acceptance rates in the new EHR.
Prescribing rates of PIMs decreased 5.2% (13.5 per 100 prescriptions to 12.8 per 100 prescriptions; < 0.0001) corresponding to the implementation of alternatives CDS in the legacy EHR. After migration of the alternative CDS from the legacy to the new EHR system, PIM prescribing rates dropped an additional 18.8% (10.4 per 100 prescriptions; < 0.0001). Acceptance rates of the alternative recommendations for PIMs was low overall at 11.1%.
The prescribing rate of PIMs in adults aged 65 years and older was successfully decreased with the implementation of prescribing CDS. This decrease was not only maintained but strengthened by the transition to a new EHR system.
美国老年医学会建议老年人避免使用某些潜在不适当的药物（PIMs）。这些药物的处方与更高的住院再入院率、发病率和死亡率相关。范德比尔特大学医学中心之前曾使用临床决策支持（CDS）来降低 PIM 处方率，但最近已过渡到新的电子健康记录（EHR）系统。
本研究旨在评估老年人在迁移到新 EHR 系统前后的 PIM 处方率。
我们回顾了 2014 年 7 月 1 日至 2019 年 12 月 31 日期间，从旧和新 EHR 系统中每 100 张总处方中标准化的 65 岁及以上成年人 PIM 处方率。使用 U 图和泊松回归模型比较 EHR 迁移前后的 PIM 处方率。次要分析描述性地评估了新 EHR 中开方者接受率的频率。
随着旧 EHR 中替代 CDS 的实施，PIM 处方率下降了 5.2%（从每 100 张处方 13.5 张降至每 100 张处方 12.8 张； < 0.0001）。替代 CDS 从旧 EHR 迁移到新 EHR 系统后，PIM 处方率又下降了 18.8%（每 100 张处方 10.4 张； < 0.0001）。总的来说，替代 PIM 建议的接受率很低，仅为 11.1%。
通过实施处方 CDS，成功降低了 65 岁及以上成年人的 PIM 处方率。这种下降不仅得到了维持，而且在过渡到新的 EHR 系统后得到了加强。
