Stroke Clinical Trial
Official title:
Improving Quality Through Decision Support for Evidence-Based Pharmacotherapy
This three-year, grant funded project will be conducted by the Division of Clinical
Informatics in the Department of Community and Family Medicine at Duke University Medical
Center. The project seeks to improve care quality and safety in an ambulatory care setting
through clinical decision support for evidence-based (EB) pharmacotherapy delivered as
point-of-care reports to clinic-based practitioners and as population health-based alerts to
care managers.
This project will build upon a regional Health Information Exchange (HIE) network created to
connect providers serving 37,000 Medicaid beneficiaries from both rural and urban settings
in a 5 county region in the Northern Piedmont of North Carolina. This network includes 16
private practices, 3 federally qualified health centers, 5 rural health centers, 3 urgent
care facilities, 10 government agencies, 5 hospitals, and 2 cross-disciplinary care
management teams.
The proposed information system will be based on an emerging standard for decision support
and will utilize routinely available claims and scheduling data in order to serve as a
replicable model for broader use of decision support for medication management. Increased
availability and use of decision support tools for medication management can be expected to
reduce medication errors, improve health care quality at an acceptable cost, and augment
disease management for patients and populations.
The study will be conducted in accordance with the following four specific aims:
Aim 1: Expand the functionality of an existing decision support system in use within a
regional HIE network to incorporate EB pharmacotherapy guidelines and to promote medication
adherence. Primary care clinicians will receive EB pharmacotherapy suggestions and a
patient-specific summary of prescription claims data delivered to the point-of-care via fax.
Care managers will receive alerts delivered via email to encourage patients to arrange
follow-up clinic appointments because of possible medication non-adherence.
Aim 2: Implement and evaluate the impact of the two interventions on adherence to EB
pharmacotherapy recommendations among Medicaid patients with high priority conditions as
designated by the Institute of Medicine (IOM) in ambulatory care settings through a
three-arm randomized controlled trial.
Aim 3: Compare resource utilization and assess the economic attractiveness (cost-savings or
cost-effectiveness) of the interventions to promote medication adherence and EB
pharmacotherapy.
Aim 4: Disseminate information regarding the development and impact of the interventions
through Web teleconferences, professional meetings, educational lectures, and peer review
journals.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Health Services Research
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