A tiered approach is more cost effective than traditional pharmacist-based review for classifying computer-detected signals as adverse drug events.
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.
Hope
Carol
C
Regenstrief Institute, Indiana University School of Medicine, 1050 Wishard Boulevard, Indianapolis, IN 46202-2872, USA.
Overhage
J Marc
JM
Seger
Andrew
A
Teal
Evgenia
E
Mills
Vera
V
Fiskio
Julie
J
Gandhi
Tejal K
TK
Bates
David W
DW
Murray
Michael D
MD
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