title: Medication-use evaluation with a Web application.
abstract: OBJECTIVE
  A Web-based application for coordinating medication-use evaluation (MUE) initiatives within the Veterans Affairs (VA) health care system is described.
  
  
  CONCLUSIONS
  The MUE Tracker (MUET) software program was created to improve VA's ability to conduct national medication-related interventions throughout its network of 147 medical centers. MUET initiatives are centrally coordinated by the VA Center for Medication Safety (VAMedSAFE), which monitors the agency's integrated databases for indications of suboptimal prescribing or drug therapy monitoring and adverse treatment outcomes. When a pharmacovigilance signal is detected, VAMedSAFE identifies "trigger groups" of at-risk veterans and uploads patient lists to the secure MUET application, where locally designated personnel (typically pharmacists) can access and use the data to target risk-reduction efforts. Local data on patient-specific interventions are stored in a centralized database and regularly updated to enable tracking and reporting for surveillance and quality-improvement purposes; aggregated data can be further analyzed for provider education and benchmarking. In a three-year pilot project, the MUET program was found effective in promoting improved prescribing of erythropoiesis-stimulating agents (ESAs) and enhanced laboratory monitoring of ESA-treated patients in all specified trigger groups. The MUET initiative has since been expanded to target other high-risk drugs, and efforts are underway to refine the tool for broader utility.
  
  
  CONCLUSIONS
  The MUET application has enabled the increased standardization of medication safety initiatives across the VA system and may serve as a useful model for the development of pharmacovigilance tools by other large integrated health care systems.
authors.affiliation: Muriel Burk, Pharm.D., is Clinical Pharmacy Specialist, Veterans Affairs (VA) Center for Medication Safety, Hines, IL. Von Moore, Pharm.D., is Research Specialist, VA Center for Medication Safety, VA Northern Indiana Health Care System, Marion. Peter Glassman, M.B.B.S., M.Sc., FACP, is Co-Director, VA Center for Medication Safety, Division of General Internal Medicine, VA Greater Los Angeles Healthcare System, West Los Angeles, CA. Chester B. Good, M.D., M.P.H., is Co-Director, VA Center for Medication Safety, Division of General Internal Medicine, VA Pittsburgh Healthcare System, Pittsburgh, PA. Thomas Emmendorfer, Pharm.D., is Assistant Chief Consultant, VA Pharmacy Benefits Management Services, Hines, IL. Thomas C. Leadholm, M.S., is Information Technology Specialist, VA Consolidated Mail Outpatient Pharmacy/VA Center for Medication Safety, Dexter, MI. Francesca Cunningham, Pharm.D., is Director, VA Center for Medication Safety, Hines.
authors.forename: Muriel
authors.initials: M
authors.lastname: Burk
authors.forename: Von
authors.initials: V
authors.lastname: Moore
authors.forename: Peter
authors.initials: P
authors.lastname: Glassman
authors.forename: Chester B
authors.initials: CB
authors.lastname: Good
authors.forename: Thomas
authors.initials: T
authors.lastname: Emmendorfer
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Leadholm
authors.forename: Francesca
authors.initials: F
authors.lastname: Cunningham
mesh_terms: D019985:Benchmarking; D016208:Databases, Factual; D016903:Drug Monitoring / Q000379:methods; D017723:Drug Utilization Review / Q000379:methods*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D006397:Hematinics / Q000627:therapeutic use; D006787:Hospitals, Veterans / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D020407:Internet; D060735:Pharmacovigilance; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000592:standards*; D016730:Program Development; D058996:Quality Improvement; D012984:Software; D014481:United States; D014728:Veterans
chemical_list: D006397:Hematinics