title: A tiered approach is more cost effective than traditional pharmacist-based review for classifying computer-detected signals as adverse drug events.
abstract: OBJECTIVE
  To develop a cost-efficient method for identifying adverse drug events (ADEs) and medication errors (MEs) identified using outpatient electronic medical records within ambulatory settings.
  
  
  METHODS
  Comparison of sensitivity and cost of "traditional" pharmacist based approach to identifying ADEs and MEs during a 4 month period with a tiered approach.
  
  
  RESULTS
  The proportion of computer generated signals analyzed identified as ADEs were similar using the two approaches while the number of MEs was nearly double with tiered reviews suggesting the same or better sensitivity. Traditional pharmacist review cost $68.70 US dollars to detect an ADE and tiered approach cost only $42.40.
  
  
  CONCLUSIONS
  Tiered review of ADEs and MEs by personnel with increasing clinical capability is more cost-efficient than pharmacist review.
authors.affiliation: Regenstrief Institute, Indiana University School of Medicine, 1050 Wishard Boulevard, Indianapolis, IN 46202-2872, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Hope
authors.forename: J Marc
authors.initials: JM
authors.lastname: Overhage
authors.forename: Andrew
authors.initials: A
authors.lastname: Seger
authors.forename: Evgenia
authors.initials: E
authors.lastname: Teal
authors.forename: Vera
authors.initials: V
authors.lastname: Mills
authors.forename: Julie
authors.initials: J
authors.lastname: Fiskio
authors.forename: Tejal K
authors.initials: TK
authors.lastname: Gandhi
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
authors.forename: Michael D
authors.initials: MD
authors.lastname: Murray
mesh_terms: D000293:Adolescent; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems / Q000191:economics*; D000368:Aged; D000465:Algorithms; D000553:Ambulatory Care / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis / Q000379:methods*; D003628:Database Management Systems; D005103:Expert Systems; D005260:Female; D006801:Humans; D016247:Information Storage and Retrieval / Q000379:methods; D008297:Male; D008508:Medication Errors / Q000145:classification* / Q000191:economics* / Q000517:prevention & control; D008875:Middle Aged; D010348:Patient Care Team; D010593:Pharmaceutical Services / Q000191:economics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity