D W Bates

..This is a commentary on http://www.ijhpr.org/content/1/1/19/..

..Still, unless Internet access becomes more broadly available, its benefits will not accrue to disadvantaged populations...

..Delay in antibiotic therapy was associated with worse outcome at the center level...

..Comprehensive knowledge about the level of healthcare information technology (HIT) adoption in the United States remains limited. We therefore performed a baseline assessment to address this knowledge gap...

..Our objective was to assess the frequency and resource utilization associated with treatment failure in cancer patients given empiric fluconazole antifungal therapy in routine inpatient care...

..However, to date there are few data available regarding the confounders of racial/ethnic disparities in the intensity of hypertension treatment...

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..The key initial policy changes will be those addressing financial incentives and interoperability...

..These changes can help close the gap between knowledge and practice and promise to make the practice of evidence-based medicine a reality...

..Washington, DC: National Academy Press, 1999) described the magnitude of the problem, and the public interest in this issue, which was already large, has grown...

..To encourage this development, policy makers should include medical homes in emerging electronic health record regulations. Additionally, more research is needed to learn how these records can enhance team care...

..This study identified correlates of ARF in amphotericin B therapy and used them to develop clinical prediction rules...

..However, major barriers still stand in the way of public access to quality information on the Internet as well as of having that access actually improve patients' care...

..Although residual confounding exists despite adjustment, the increases in resource utilization that we found are large and the associated mortality is high when acute renal failure occurs following amphotericin B therapy...

..Nevertheless, barriers to adoption exist and must be overcome. Implementing specific policies can accelerate utilization of EMRs in the U.S...

..Information technology techniques can detect some adverse events in a timely and cost-effective way, in some cases early enough to prevent patient harm...

..To summarize key recommendations and supporting evidence from the most recent Institute of Medicine (IOM) report, Preventing Medication Errors...

..Clinicians need better approaches for identifying patients most likely to benefit from screening, systems that facilitate their application, and test results that are easy to interpret...

..As described in the Institute of Medicine's Crossing the Quality Chasm report, the quality of health care in the U.S. today leaves much to be desired...

..v.) drug administration, and alerts can be provided if dosages fall outside pre-established limits. High variation levelsare common in medical care but can increase safety risk if the variation is unnecessary...

..The goal of this report is to discuss these lessons learned in the interest of informing the efforts of others working to make the practice of evidence-based medicine a reality...

..Finally, organizations need to strive for a "culture of safety" by providing opportunities to discuss errors and adverse events in constructive, supportive environments and by resisting pressure to find a scapegoat...

..A small proportion do have the potential to cause injury, and some cause preventable adverse drug events...

..To evaluate the effect of an automatic alerting system on the time until treatment is ordered for patients with critical laboratory results...

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..Although retrospective identification of adverse events is time-consuming, whether they are present and/or expected is often readily apparent to providers during the provision of care...

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..Preliminary results indicate that the new computer-based process is faster...

..These data suggest that it is possible to design computerized prescribing decision support with high rates of alert recommendation acceptance by clinicians...

..While many guidelines, admonitions, and rules exist regarding drugs and the laboratory, substantial new knowledge and evidence in this area are needed. Focusing on these unmet needs and accompanying logistical challenges is a priority...

..Most studies rely on retrospective consumer surveys rather then more intensive data collection methods, possibly underestimating the incidence of service quality incidents...

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..Although few data are available, many believe that part-time primary care physicians (PCPs) are less productive and provide lower quality care than full-time PCPs. Some insurers exclude part-time PCPs from their provider networks...

..Such systems make feasible implementation of care improvement and cost reduction initiatives on a scale which could not previously be considered...

..Preliminary results indicate that the new computer-based referral process is faster to use than conventional methods...

..Most monitors have been developed in large academic hospitals and are not readily usable in other settings. We assessed the ability of a commercial program to identify and prevent ADEs in a community hospital...

..The sustained benefit supports the idea that computerized interventions may durably affect physician behavior. Computerized delivery of such evidence-based boundary guidelines can help narrow the gap between evidence and practice...

..Development, implementation, and assessment of such interventions in the pediatric inpatient setting are needed...

..CONCLUSION: An integrated electronic reminder system resulted in variable improvement in care for diabetes and CAD. These improvements were often limited and quality gaps persist...

..Our results indicate a need for better communication about potential side effects of medications, especially for patients with multiple medical problems...

..Optimal prevention strategies should cover many types of drugs and target physicians' ordering practices...

..32-0.98). The method of ADE and medication error detection and classification described is feasible and has good reliability. It can be used in various clinical settings to measure and improve medication safety...

..This study assesses the impact of an inpatient computerized physician order entry system on prescribing practices...

..A physician reminder alone did not have an effect...

..Based on these findings, we have made specific recommendations for increasing the specificity of alerting and thereby improving the clinical utility of the drug allergy alerting system...

..As new therapies become available for patients with sepsis syndromes, the ability to predict mortality risk may be helpful in triage and treatment decisions...

..Our objectives were to determine how frequently clinicians prescribe drugs in violation of black box warnings for these issues and to determine how frequently such prescribing results in harm...

..In a statewide initiative we developed a framework for (1) selecting two safe practices, (2) developing operational details of implementation, (3) enlisting hospitals to participate, and (4) facilitating implementation...

..Information obtained from the general survey and referral-specific survey was congruent. Efforts to improve the referral system could improve both physician satisfaction and quality of patient care...

..05). When we compared ancillary utilization within the five largest diagnosis-related groups, these differences persisted. CONCLUSIONS: Men receive more ancillary services than women, even after adjusting for potential confounders...

..Medication errors are common, costly, and injurious to patients...

..Public and private mandates for information technology interventions are growing, but further development, application, evaluation, and dissemination are required...

..Sepsis syndrome is a leading cause of mortality in hospitalized patients. However, few studies have described the epidemiology of sepsis syndrome in a hospitalwide population...

..CONCLUSIONS: Medication errors are common in pediatric inpatient settings, and further efforts are needed to reduce them...

..Nonetheless, computerized clinical narrative screening methods could potentially offer researchers and quality managers a means to routinely detect adverse events...

..Although many types of errors were identified, failure to carry out intended treatment correctly was the leading category...

..These data sources vary in the timing of the reporting (retrospective or prospective), severity of the events, and profession of the reporters...

..Nonetheless, consensus about some issues has been reached, in particular because of a well delineated patient safety structure. We believe the net result will be substantial improvement in patient safety...

..Although sleep deprivation has been shown to impair neurobehavioral performance, few studies have measured its effects on medical errors...

..However, evidence regarding their effectiveness for this purpose is mixed, and existing studies have generally considered EHR usage a binary factor and have not considered the availability and use of specific EHR features...

..Pharmacist-based interventions may be effective in promoting the safe and effective use of medications, especially among high-risk patients such as those with low health literacy...

..Adjusting the findings for the presence of psychiatric and medical comorbidity had relatively little effect on this association...

..These events were mostly severe, often preventable, and expensive. The computer-based monitoring system represents a practical approach for identifying ADEs that occur in outpatients and cause admission to the hospital...

..While evidence suggests that many patients are undertreated, comparatively few data are available regarding overtreatment...

..Medications represent a major cause of harm and are costly for hospitalized patients, but more is known about these issues in large academic hospitals than in smaller hospitals...

..Given that a small group of providers care for most racial/ethnic minorities, we sought to determine whether minority-serving providers adopt EHR systems at comparable rates to other providers...

..In the pediatric setting, adverse events occurring at the administration stage are the most common type of preventable adverse drug events. Few data are available on the effect of advice from medical professionals on medication safety...

..0; moderate, odds ratio of 2.5; and high, odds ratio of 4.7. CONCLUSIONS: This study suggests that the Charlson Index predicts one-year mortality among ED patients with suspected infection...

..However, adoption has been slow, and a key concern has been that clinicians will require more time to complete their work using EHRs. Most previous studies addressing this issue have been done in primary care...

..The objective of this study was to assess the impact of physicians' use of a test results management tool embedded in an electronic health record on patient satisfaction with test result communication...

..Data collected by means of the presented approach provide a basis for the development of effective strategies to reduce the risk of medication errors and thus improve patient safety in psychiatric care...

..Accordingly, the goal of this study was to learn whether electronic medication safety messages directed to patients can improve communication about medications and identify ADEs...

..We hypothesized that patients who reported poor service quality were at increased risk of experiencing adverse events and medical errors...

..CONCLUSIONS: Potential fluconazole drug interactions were very frequent among hospitalized patients on systemic azole antifungal therapy, but they had few apparent clinical consequences...

..While the EHR did not require more time for physicians during a clinic session, further studies should assess the EHR's potential impact on non-clinic time...

..Additional investigation is required to determine how much of the excess post-onset LOS and charges are attributable to sepsis syndrome rather than the underlying medical conditions...

..To examine the resource utilization of patients with high levels of somatization and health-related anxiety...

..To examine factors associated with musculoskeletal referral and determine whether referral influences clinical outcomes...

..The purpose of this study was to measure the impact of presenting real time, evidence-based critiques about the appropriateness of abdominal radiograph (KUB) orders on physician decision making...

..The success of intervention varies by type of complications. For medications, various interventions have been successful, and fall prevention programs have been demonstrated to be effective in the nursing home and home...

..We conclude that while CPOE has many benefits, it represents a major process change, and organizations must factor this in when they implement it...

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..Interventions to reduce disparities in cardiovascular outcomes should consider the need to intensify drug therapy more aggressively among all high-risk populations...

..Inappropriate use or excessive dosing of psychotropic medications in the elderly is common and can lead to a variety of adverse drug events including falls, oversedation, and cognitive impairment...

..Electronic health records (EHRs) allow for a variety of functions, ranging from visit documentation to laboratory test ordering, but little is known about physicians' actual use of these functions...

..To determine whether outpatient cholesterol management varies by gender or race among patients with atherosclerosis, and assess factors related to subsequent cholesterol control...

..In Massachusetts, regional projects have helped to address these barriers, and e-Prescribing activities are accelerating rapidly within the state...

..We evaluated the impact of electronic reminders delivered to primary care physicians on rates of appropriate routine medication laboratory monitoring...

..Patients' knowledge of the indications of their prescription medications was studied and those medications that were most likely to be taken without patients understanding the correct indication were identified...

..Accordingly, the purpose of this study was to elicit incident reports from hospital inpatients in order to identify and characterize adverse events and near-miss errors...

..A CLR was defined as a result that met either the critical reporting criteria used by the laboratory at Brigham and Women's Hospital or other, more complex criteria...

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..Adverse drug events (ADEs) are common in hospitalized patients, but few empirical data are available regarding the strength of patient risk factors for ADEs...

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..We believe the results of our work will improve patient safety and the overall quality of pharmacotherapy. We also believe that the results of our study will be applicabe to other healthcare systems ..

..Dissemination of the results of this work should speed efforts toward the establishment of a national health information infrastructure. ..

..In addition, we will build and bolster educational tools and programs to assist with therapeutics and HIT. ..