title: Improving medication safety: Development and impact of a multivariate model-based strategy to target high-risk patients.
abstract: BACKGROUND
  Preventive strategies to reduce clinically significant medication errors (MEs), such as medication review, are often limited by human resources. Identifying high-risk patients to allow for appropriate resource allocation is of the utmost importance. To this end, we developed a predictive model to identify high-risk patients and assessed its impact on clinical decision-making.
  
  
  METHODS
  From March 1st to April 31st 2014, we conducted a prospective cohort study on adult inpatients of a 1,644-bed University Hospital Centre. After a clinical evaluation of identified MEs, we fitted and internally validated a multivariate logistic model predicting their occurrence. Through 5,000 simulated randomized controlled trials, we compared two clinical decision pathways for intervention: one supported by our model and one based on the criterion of age.
  
  
  RESULTS
  Among 1,408 patients, 365 (25.9%) experienced at least one clinically significant ME. Eleven variables were identified using multivariable logistic regression and used to build a predictive model which demonstrated fair performance (c-statistic: 0.72). Major predictors were age and number of prescribed drugs. When compared with a decision to treat based on the criterion of age, our model enhanced the interception of potential adverse drug events by 17.5%, with a number needed to treat of 6 patients.
  
  
  CONCLUSIONS
  We developed and tested a model predicting the occurrence of clinically significant MEs. Preliminary results suggest that its implementation into clinical practice could be used to focus interventions on high-risk patients. This must be confirmed on an independent set of patients and evaluated through a real clinical impact study.
authors.affiliation: Department of Pharmacy, Nîmes University Hospital, Nîmes, France.|Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, University Institute of Clinical Research, Montpellier University, Montpellier, France.|Departments of Anesthesia, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.|Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, Ontario, Canada.
authors.forename: Tri-Long
authors.initials: TL
authors.lastname: Nguyen
authors.affiliation: Department of Pharmacy, Nîmes University Hospital, Nîmes, France.|Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, University Institute of Clinical Research, Montpellier University, Montpellier, France.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Leguelinel-Blache
authors.affiliation: Department of Pharmacy, Nîmes University Hospital, Nîmes, France.|Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, University Institute of Clinical Research, Montpellier University, Montpellier, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Kinowski
authors.affiliation: Department of Pharmacy, Nîmes University Hospital, Nîmes, France.|Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, University Institute of Clinical Research, Montpellier University, Montpellier, France.
authors.forename: Clarisse
authors.initials: C
authors.lastname: Roux-Marson
authors.affiliation: Department of General Medicine, Nîmes University Hospital, Nîmes, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Rougier
authors.affiliation: Departments of Anesthesia, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.|Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, Ontario, Canada.
authors.forename: Jessica
authors.initials: J
authors.lastname: Spence
authors.affiliation: Departments of Anesthesia, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.|Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, Ontario, Canada.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Le Manach
authors.affiliation: Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, University Institute of Clinical Research, Montpellier University, Montpellier, France.|Department of Biostatistics, Epidemiology, Clinical Research and Health Economics, Nîmes University Hospital, Nîmes, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Landais
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making / Q000379:methods*; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D017751:Safety Management / Q000379:methods*