title: IT-enabled systems engineering approach to monitoring and reducing ADEs.
abstract: OBJECTIVE
  To develop and pilot-test a Web-based implementation of a team resource management (TRM) intervention to improve medication safety in primary care.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Eight practices were randomized to either the Web-based TRM or usual practice (4 practices in each group). Primary outcome was adverse drug events (ADEs) in older adults, ascertained using a trigger tool chart review at two 12-month periods (before and after the intervention). The prospective TRM approach, designed to inculcate ownership and empowerment, facilitates systematic appraisal of risk and error reduction. This approach uses the highly adaptable and transferable Safety Enhancement and Monitoring Instrument that is Patient Centered.
  
  
  RESULTS
  The rate of ADEs decreased from 25.8 to 18.3 per 100 patients per year in the intervention group. The rate was virtually unchanged in the control group (24.3 vs 24.8). In an analysis of covariance at the practice level, being in the intervention group was associated with a lower rate of ADEs. The interaction between time (preintervention vs postintervention) and group (intervention vs control) was not signifi cant (P = .104) but showed a trend toward a decrease in the intervention group compared with the control group over time.
  
  
  CONCLUSIONS
  The Web-based TRM intervention proved feasible and demonstrated potential for effectiveness in various ambulatory settings. This pilot study was limited by small size and short follow-up period. Future studies should test the intervention on a larger scale over a longer period of time and should explore methods for overcoming common barriers to change.
authors.affiliation: Deparment of Family Medicine, State University of New York at Buffalo, NY, USA. gsingh4@buffalo.edu
authors.forename: Ranjit
authors.initials: R
authors.lastname: Singh
authors.forename: Diana
authors.initials: D
authors.lastname: Anderson
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McLean-Plunkett
authors.forename: Ron
authors.initials: R
authors.lastname: Brooks
authors.forename: Angela
authors.initials: A
authors.lastname: Wisniewski
authors.forename: Nikhil
authors.initials: N
authors.lastname: Satchidanand
authors.forename: Gurdev
authors.initials: G
authors.lastname: Singh
mesh_terms: D000704:Analysis of Variance; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D019538:Health Care Surveys; D006751:Hospital Information Systems / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control*; D009862:Online Systems; D010865:Pilot Projects; D016730:Program Development; D015397:Program Evaluation; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D013223:Statistics as Topic; D013597:Systems Analysis; D014481:United States