Development and pilot testing of computerized order entry algorithms for geriatric problems in nursing homes.
OBJECTIVE
To develop order entry algorithms for five common nursing home problems and to test their acceptance, use, and preliminary effect on nine quality indicators and resource utilization.


METHODS
Pre-post, quasi-experimental study.


METHODS
Two Department of Veterans Affairs nursing homes.


METHODS
Randomly selected residents (N=265) with one or more target conditions and 42 nursing home providers.


METHODS
Expert panels developed computerized order entry algorithms based on clinical practice guidelines. Each was displayed on a single screen and included an array of diagnostic and treatment options and means to communicate with the interdisciplinary team.


METHODS
Medical records were abstracted for the 6 months before and after deployment for quality indicators and resource utilization.


RESULTS
Despite positive provider attitudes toward the computerized order entry algorithms, their use was infrequent and varied according to condition: falls (73.0%), fever (9.0%), pneumonia (8.0%), urinary tract infection (7.0%), and osteoporosis (3.0%). In subjects with falls, trends for improvements in quality measures were observed for six of the nine measures: measuring orthostatic blood pressure (17.5-30.0%, P=.29), reducing neuroleptics (53.8-75.0%, P=.27), reducing sedative-hypnotics (16.7-50.0%, P=.50), prescription of calcium (22.5-32.5%, P=.45), vitamin D (20.0-35.0%, P=.21), and external hip protectors (25.0-47.5%, P=.06). Little improvement was observed in the other conditions (documentation of vital signs, physical therapy referrals, or reduction of benzodiazepines or antidepressants). There was no change in resource utilization.


CONCLUSIONS
Computerized order entry algorithms were used infrequently, except for falls. Further study may determine whether their use leads to improved care.
Colón-Emeric
Cathleen S
CS
Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA. colon001@mc.duke.edu
Schmader
Kenneth E
KE
Twersky
Jack
J
Kuchibhatla
Maragantha
M
Kellum
Sally
S
Weinberger
Morris
M
D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002908:Chronic Disease / Q000628:therapy*; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine / Q000191:economics / Q000458:organization & administration; D005240:Feasibility Studies; D005260:Female; D005335:Fever of Unknown Origin / Q000628:therapy; D005598:Fractures, Spontaneous / Q000517:prevention & control; D006707:Homes for the Aged / Q000191:economics; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems / Q000458:organization & administration*; D009735:Nursing Homes / Q000191:economics; D010024:Osteoporosis / Q000628:therapy; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration; D018410:Pneumonia, Bacterial / Q000628:therapy; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D014552:Urinary Tract Infections / Q000628:therapy
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