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Empirical research

Assessing the Potential Adoption and Usefulness of Concurrent, Action-Oriented, Electronic Adverse Drug Event Triggers Designed for the Outpatient Setting

Authors:

Hillary J. Mull ,

Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System; Department of Surgery, Boston University School of Medicine
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Amy K. Rosen,

Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System; Department of Surgery, Boston University School of Medicine
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Stephanie L. Shimada,

Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital; Department of Quantitative Health Sciences, University of Massachusetts Medical School; Boston University School of Public Health
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Peter E. Rivard,

Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System; Sawyer Business School, Suffolk University
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Brian Nordberg,

Health Catalyst
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Brenna Long,

Geriatrics Research Education and Clinical Center, VA Salt Lake City Health Care System; University of Utah
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Jennifer M. Hoffman,

Geriatrics Research Education and Clinical Center, VA Salt Lake City Health Care System; University of Utah
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Molly Leecaster,

Geriatrics Research Education and Clinical Center, VA Salt Lake City Health Care System; University of Utah
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Lucy A. Savitz,

University of Utah; Intermountain Healthcare
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Christopher W. Shanahan,

Boston University School of Medicine; Boston Medical Center
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Amy Helwig,

Office of the National Coordinator for Health IT
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Jonathan R. Nebeker

Geriatrics Research Education and Clinical Center, VA Salt Lake City Health Care System; University of Utah
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Abstract

Background: Adverse drug event (ADE) detection is an important priority for patient safety research. Trigger tools have been developed to help identify ADEs. In previous work we developed seven concurrent, action-oriented, electronic trigger algorithms designed to prompt clinicians to address ADEs in outpatient care.

Objectives: We assessed the potential adoption and usefulness of the seven triggers by testing the positive predictive validity and obtaining stakeholder input.

Methods: We adapted ADE triggers, “bone marrow toxin - white blood cell count (BMT‑WBC),” “bone marrow toxin - platelet (BMT-platelet),” “potassium raisers,” “potassium reducers,” “creatinine,” “warfarin,” and “sedative hypnotics,” with logic to suppress flagging events with evidence of clinical intervention and applied the triggers to 50,145 patients from three large health care systems. Four pharmacists assessed trigger positive predictive value (PPV) with respect to ADE detection (conservatively excluding ADEs occurring during clinically appropriate care) and clinical usefulness (i.e., whether the trigger alert could change care to prevent harm). We measured agreement between raters using the free kappa and assessed positive PPV for the trigger’s detection of harm, clinical usefulness, and both. Stakeholders from the participating health care systems rated the likelihood of trigger adoption and the perceived ease of implementation.

Findings: Agreement between pharmacist raters was moderately high for each ADE trigger (kappa free > 0.60). Trigger PPVs for harm ranged from 0 (Creatinine, BMT-WBC) to 17 percent (potassium raisers), while PPV for care change ranged from 0 (WBC) to 60 percent (Creatinine). Fifteen stakeholders rated the triggers. Our assessment identified five of the seven triggers as good candidates for implementation: Creatinine, BMT-Platelet, Potassium Raisers, Potassium Reducers, and Warfarin.

Conclusions: At least five outpatient ADE triggers performed well and merit further evaluation in outpatient clinical care. When used in real time, these triggers may promote care changes to ameliorate patient harm.

How to Cite: Mull HJ, Rosen AK, Shimada SL, Rivard PE, Nordberg B, Long B, et al.. Assessing the Potential Adoption and Usefulness of Concurrent, Action-Oriented, Electronic Adverse Drug Event Triggers Designed for the Outpatient Setting. eGEMs (Generating Evidence & Methods to improve patient outcomes). 2015;3(1):10. DOI: http://doi.org/10.13063/2327-9214.1116
Published on 30 Apr 2015.
Peer Reviewed

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