A randomized evaluation of a computer-based physician's workstation: design considerations and baseline results.
We are performing a randomized, controlled trial of a Physician's Workstation (PWS), an ambulatory care information system, developed for use in the General Medical Clinic (GMC) of the Palo Alto VA. Goals for the project include selecting appropriate outcome variables and developing a statistically powerful experimental design with a limited number of subjects. As PWS provides real-time drug-ordering advice, we retrospectively examined drug costs and drug-drug interactions in order to select outcome variables sensitive to our short-term intervention as well as to estimate the statistical efficiency of alternative design possibilities. Drug cost data revealed the mean daily cost per physician per patient was 99.3 cents +/- 13.4 cents, with a range from 0.77 cent to 1.37 cents. The rate of major interactions per prescription for each physician was 2.9% +/- 1%, with a range from 1.5% to 4.8%. Based on these baseline analyses, we selected a two-period parallel design for the evaluation, which maximized statistical power while minimizing sources of bias.
Rotman
B L
BL
Department of Veterans Affairs Medical Center, Palo Alto, CA, USA.
Sullivan
A N
AN
McDonald
T
T
DeSmedt
P
P
Goodnature
D
D
Higgins
M
M
Suermondt
H J
HJ
Young
C Y
CY
Owens
D K
DK
D000555:Ambulatory Care Information Systems; D016303:Clinical Pharmacy Information Systems; D016527:Drug Costs / Q000706:statistics & numerical data*; D004347:Drug Interactions; D004363:Drug Utilization; D006801:Humans; D009862:Online Systems; D017063:Outcome Assessment, Health Care; D019095:Point-of-Care Systems; D010818:Practice Patterns, Physicians' / Q000191:economics; D011785:Quality Assurance, Health Care; D012107:Research Design; D012189:Retrospective Studies