A computer-based intervention for improving the appropriateness of antiepileptic drug level monitoring

Philip Chen, Milenko J. Tanasijevic, Ronald A. Schoenenberger, Julie Fiskio, Gilad J. Kuperman, David W. Bates

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

We designed and implemented 2 automated, computerized screens for use at the time of antiepileptic drug (AED) test order entry to improve appropriateness by reminding physicians when a potentially redundant test was ordered and providing common indications for monitoring and pharmacokinetics of the specific AED. All computerized orders for inpatient serum AED levels during two 3-month periods were included in the study. During the 3-month period after implementation of the automated intervention, 13% of all AED tests ordered were canceled following computerized reminders. For orders appearing redundant, the cancellation rate was 27%. For nonredundant orders, 4% were canceled when information on specific AED monitoring and pharmacokinetics was provided. The cancellation rate was sustained after 4 years. There has been a 19.5% decrease in total AED testing volume since implementation of this intervention, despite a 19.3% increase in overall chemistry test volume. Inappropriateness owing to repeated testing before pharmacologic steady state was reached decreased from 54% of all AED orders to 14.6%. A simple, automated, activity-based intervention targeting a specific testordering behavior effectively reduced inappropriate laboratory testing. 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.

Original languageEnglish
Pages (from-to)432-438
Number of pages7
JournalAmerican Journal of Clinical Pathology
Volume119
Issue number3
StatePublished - Mar 1 2003

Fingerprint

Drug Monitoring
Anticonvulsants
Pharmacokinetics
Physicians
Inpatients
Guidelines
Serum

Keywords

  • Antiepileptic drug level
  • Appropriateness
  • Benchmark
  • Evidence-based medicine
  • Guidelines
  • Indicators
  • Test ordering
  • Utilization

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Chen, P., Tanasijevic, M. J., Schoenenberger, R. A., Fiskio, J., Kuperman, G. J., & Bates, D. W. (2003). A computer-based intervention for improving the appropriateness of antiepileptic drug level monitoring. American Journal of Clinical Pathology, 119(3), 432-438.

A computer-based intervention for improving the appropriateness of antiepileptic drug level monitoring. / Chen, Philip; Tanasijevic, Milenko J.; Schoenenberger, Ronald A.; Fiskio, Julie; Kuperman, Gilad J.; Bates, David W.

In: American Journal of Clinical Pathology, Vol. 119, No. 3, 01.03.2003, p. 432-438.

Research output: Contribution to journalArticle

Chen, P, Tanasijevic, MJ, Schoenenberger, RA, Fiskio, J, Kuperman, GJ & Bates, DW 2003, 'A computer-based intervention for improving the appropriateness of antiepileptic drug level monitoring', American Journal of Clinical Pathology, vol. 119, no. 3, pp. 432-438.
Chen P, Tanasijevic MJ, Schoenenberger RA, Fiskio J, Kuperman GJ, Bates DW. A computer-based intervention for improving the appropriateness of antiepileptic drug level monitoring. American Journal of Clinical Pathology. 2003 Mar 1;119(3):432-438.
Chen, Philip ; Tanasijevic, Milenko J. ; Schoenenberger, Ronald A. ; Fiskio, Julie ; Kuperman, Gilad J. ; Bates, David W. / A computer-based intervention for improving the appropriateness of antiepileptic drug level monitoring. In: American Journal of Clinical Pathology. 2003 ; Vol. 119, No. 3. pp. 432-438.
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