Health Information Technology in the Nursing Home (Massachusetts)


The magnitude and intensity of medication use among our nation's 1.6 million nursing home residents matches or exceeds that of hospitalized patients. The residents of nursing homes are among the most frail patients in the population; the challenges of using medications in this setting are great, not only because of the physiologic declines and pharmacologic changes that occur with aging, but also because of the special clinical and social circumstances that often characterize nursing home care. In our previous research, we have determined that medication errors resulting in adverse drug events occur most often at the ordering and monitoring stages of pharmaceutical care. Clinical decision-support systems are clinical consultation systems that combine individual patient information with population statistics and scientific evidence to offer real-time information to health care providers. These systems have been found to improve the quality of medication prescribing in the hospital setting. In this study, we determined the extent to which a computer-based clinical decision-support system (accompanying computerized provider order-entry) can improve the quality of medication ordering and monitoring for residents in the long-term care setting through a randomized trial. We tracked the costs associated with this system and the system's impact on the productivity of providers. We also assessed the culture of U.S. nursing homes and the organization of the nursing home setting with respect to readiness to incorporate computerized provider order-entry with computer-based clinical decision support. Our project addressed specific areas that are of particular interest to AHRQ with special relevance to the delivery of high-quality care to a priority population--the frail elderly patient population residing in nursing homes. The project assessed the economic implications of health information technology in the nursing home environment that is of interest to key stakeholders, including physicians, pharmacists, nurses, payers, policymakers, the nursing home industry, and pharmaceutical vendors to long-term care institutions.

Grant Number: 
R01 HS015430
Funding Mechanism: 
Demonstrating the Value of Health Information Technology
AHRQ Funded Amount: 
Principal Investigator: 
Gurwitz, Jerry
University of Massachusetts Medical School
Project Dates: 
September 30, 2004 to September 29, 2008
Project Status: 

Project Categories

Type of Health Information Technology: 
Clinical Decision Support (CDS) System
Computerized Provider Order Entry (CPOE)
Care Setting: 
Long-Term Care
Aspect of Care: 
Medication Management
Target Population: 
Kidney Disease
Mental Health/Depression
Last Modified: August 2015

News and Publications

Gurwitz J. Health Information Technology in the Nursing Home - Final Report. (Prepared by the University of Massachusetts Medical School - Worcester under Grant No. R01 HS015430). Rockville, MD: Agency for Healthcare Research and Quality, 2009. (PDF, 102.47 KB)
The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

Project Activities