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Elderly/Long-Term Care

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Financial incentives to physicians and long-term care facilities may foster adoption of computerized drug systems

Patient harm from medication errors is a common problem in nursing homes. Computerized physician/provider order entry (CPOE) with clinical decision support (CDS) has been proposed as one approach for reducing medication errors and preventable drug-related injuries. Various long-term care stakeholders share different costs and benefits of CPOE with CDS, concludes a new study by Sujha Subramanian, Ph.D., and colleagues.

Physicians and long-term care facilities are likely to bear a large burden of the costs. For example, nursing homes will have substantial start-up costs if these costs are not shared with other stakeholders such as the payer, laboratory, or pharmacy. They will also have training costs and lost productivity as staff become familiar with the system. Physicians (and nurse practitioners) are likely to devote more time to ordering medications using CPOE with CDS. If not compensated for these additional tasks, they will bear the cost burden. Some important benefits, including less need to clarify orders from the pharmacy and fewer requests to address pharmaco-therapeutic issues from the consultant pharmacist, may offset this increased effort by prescribers.

In contrast, long-term care residents and payers will enjoy a large portion of the benefits of these computerized systems. These benefits range from efficiency gains in nursing homes, laboratories, and pharmacies to a decrease in billing errors and reduction in adverse drug events and associated medical costs. Benefits also include better patient health-related quality of life, improved ability to produce patient education materials and medication lists, and more capacity to conduct research to further improve patient care.

The study was supported by the Agency for Healthcare Research and Quality (HS10481 and HS15430).

See "Computerized physician order entry with clinical decision support in long-term care facilities: Costs and benefits to stakeholders," by Sujha Subramanian, Ph.D., Sonja Hoover, M.P.P., Boyd Gilman, Ph.D., and others, in the September 2007 Journal of the American Geriatric Society 55, pp. 1451-1457.

Reprints (AHRQ Publication No. 08-R004) are available from the AHRQ Publications Clearinghouse.

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