Guided medication dosing for inpatients with renal insufficiency

• HIT Description: Computerized decision support system in addition to computerized order entry. More info...
  
• Purpose of Study: To assess whether a computerized decision support system improves drug prescribing and patient outcomes in patients with renal insufficiency.
  
• Years of study: 1997-1998
  
• Study Design: Controlled trial with alternating eight-week blocks of intervention and control periods.
  
• Outcomes: Utilization of services and costs
  

• Settings: Large urban academic hospital with 720 beds.
• Intervention: Computer application that ran on the existing Brigham Integrated Computing System, and which detected the presence of renal insufficiency when medications were ordered, and made suggestions regarding medications, dose amount, and frequency of administration.
• Evaluation Method: Assessment of utilization of drugs, length of stay, and costs.
• Description: Brigham Integrated Computing System, which provides administrative and clinical computing services at the Brigham and Women's Hospitals. This order entry application provides the physician with a range of possible dose amounts for that medication. The clinicians also offered a highlighted frequency as the recommend dosing interval.
• Interoperability: Nearly all laboratory, radiology, and pathology results, admissions, vital signs, and demographic information can be accessed.
• Healthcare Utilization: Adjusted mean length of stay decreased from 4.5 to 4.3 days during the intervention period.
• Quality of Care and Patient Safety Outcome: During the intervention period the frequency of appropriate orders was 51% compared to 30% in the control, and 67% compared to 54% for orders involving dose changes, and 59% compared to 35% for orders involving frequency changes.
• Changes in healthcare costs: No significant differences in adjusted mean total or pharmacy costs between the intervention control periods.