title: Effect of computerized provider order entry with clinical decision support on adverse drug events in the long-term care setting.
abstract: OBJECTIVE
  To evaluate the efficacy of computerized provider order entry with clinical decision support for preventing adverse drug events in long-term care.
  
  
  METHODS
  Cluster-randomized controlled trial.
  
  
  METHODS
  Two large long-term care facilities.
  
  
  METHODS
  One thousand one hundred eighteen long-term care residents of 29 resident care units.
  
  
  METHODS
  The 29 resident care units, each with computerized provider order entry, were randomized to having a clinical decision support system (intervention units) or not (control units).
  
  
  METHODS
  The number of adverse drug events, severity of events, and whether the events were preventable.
  
  
  RESULTS
  Within intervention units, 411 adverse drug events occurred over 3,803 resident-months of observation time; 152 (37.0%) were deemed preventable. Within control units, there were 340 adverse drug events over 3,257 resident-months of observation time; 126 (37.1%) were characterized as preventable. There were 10.8 adverse drug events per 100 resident-months and 4.0 preventable events per 100 resident-months on intervention units. There were 10.4 adverse drug events per 100 resident-months and 3.9 preventable events per 100 resident-months on control units. Comparing intervention and control units, the adjusted rate ratios were 1.06 (95% confidence interval (CI)=0.92-1.23) for all adverse drug events and 1.02 (95% CI=0.81-1.30) for preventable adverse drug events.
  
  
  CONCLUSIONS
  Computerized provider order entry with decision support did not reduce the adverse drug event rate or preventable adverse drug event rate in the long-term care setting. Alert burden, limited scope of the alerts, and a need to more fully integrate clinical and laboratory information may have affected efficacy.
authors.affiliation: Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Clinic, and Fallon Community Health Plan, Worcester, Massachusetts 01605, USA. jgurwitz@meyersprimary.org
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
authors.forename: Terry S
authors.initials: TS
authors.lastname: Field
authors.forename: Paula
authors.initials: P
authors.lastname: Rochon
authors.forename: James
authors.initials: J
authors.lastname: Judge
authors.forename: Leslie R
authors.initials: LR
authors.lastname: Harrold
authors.forename: Chaim M
authors.initials: CM
authors.lastname: Bell
authors.forename: Monica
authors.initials: M
authors.lastname: Lee
authors.forename: Kathleen
authors.initials: K
authors.lastname: White
authors.forename: Jane
authors.initials: J
authors.lastname: LaPrino
authors.forename: Janet
authors.initials: J
authors.lastname: Erramuspe-Mainard
authors.forename: Martin
authors.initials: M
authors.lastname: DeFlorio
authors.forename: Linda
authors.initials: L
authors.lastname: Gavendo
authors.forename: Joann L
authors.initials: JL
authors.lastname: Baril
authors.forename: George
authors.initials: G
authors.lastname: Reed
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D050316:Medical Order Entry Systems