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 language | English |
|---|---|
| Pages (from-to) | 432-438 |
| Number of pages | 7 |
| Journal | American Journal of Clinical Pathology |
| Volume | 119 |
| Issue number | 3 |
| State | Published - Mar 1 2003 |
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Keywords
- Antiepileptic drug level
- Appropriateness
- Benchmark
- Evidence-based medicine
- Guidelines
- Indicators
- Test ordering
- Utilization
ASJC Scopus subject areas
- Pathology and Forensic Medicine
Cite this
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 journal › Article
}
TY - JOUR
T1 - A computer-based intervention for improving the appropriateness of antiepileptic drug level monitoring
AU - Chen, Philip
AU - Tanasijevic, Milenko J.
AU - Schoenenberger, Ronald A.
AU - Fiskio, Julie
AU - Kuperman, Gilad J.
AU - Bates, David W.
PY - 2003/3/1
Y1 - 2003/3/1
N2 - 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.
AB - 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.
KW - Antiepileptic drug level
KW - Appropriateness
KW - Benchmark
KW - Evidence-based medicine
KW - Guidelines
KW - Indicators
KW - Test ordering
KW - Utilization
UR - http://www.scopus.com/inward/record.url?scp=0037364370&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0037364370&partnerID=8YFLogxK
M3 - Article
C2 - 12645347
AN - SCOPUS:0037364370
VL - 119
SP - 432
EP - 438
JO - American Journal of Clinical Pathology
JF - American Journal of Clinical Pathology
SN - 0002-9173
IS - 3
ER -