title: Improving appropriateness of acid-suppressive medication use via computerized clinical decision support.
abstract: As part of the Choosing Wisely Campaign, the Society of Hospital Medicine identified reducing inappropriate use of acid-suppressive medication for stress ulcer prophylaxis as 1 of 5 key opportunities to improve the value of care for hospitalized patients. We designed a computerized clinical decision support intervention to reduce use of acid-suppressive medication for stress ulcer prophylaxis in hospitalized patients outside of the intensive care unit at an academic medical center. Using quasiexperimental interrupted time series analysis, we found that the decision support intervention resulted in a significant reduction in use of acid-suppressive medication with stress ulcer prophylaxis selected as the only indication, a nonsignificant reduction in overall use, and no change in use on discharge. We found low rates of use of acid-suppressive medication for the purpose of stress ulcer prophylaxis even before the intervention, and continuing preadmission medication was the most commonly selected indication throughout the study. Our results suggest that attention should be focused on both the inpatient and outpatient settings when designing future initiatives to improve the appropriateness of acid-suppressive medication use.
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts.
authors.forename: Shoshana J
authors.initials: SJ
authors.lastname: Herzig
authors.forename: Jamey R
authors.initials: JR
authors.lastname: Guess
authors.forename: David B
authors.initials: DB
authors.lastname: Feinbloom
authors.forename: May
authors.initials: M
authors.lastname: Adra
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Afonso
authors.forename: Michael D
authors.initials: MD
authors.lastname: Howell
authors.forename: Edward R
authors.initials: ER
authors.lastname: Marcantonio
mesh_terms: D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D020000:Decision Support Systems, Clinical / Q000592:standards* / Q000639:trends; D005260:Female; D006801:Humans; D065186:Interrupted Time Series Analysis / Q000592:standards* / Q000639:trends; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000175:diagnosis / Q000188:drug therapy; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D013276:Stomach Ulcer / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors