Clinical Trials About "Electronic prescribing ambulatory care setting cluster randomized trial"

Impact of Vendor Systems on Ambulatory Medication Safety

Our objective is to determine the effects of electronic prescribing on medication safety including medication errors, near misses and preventable adverse drug events in the ambulatory setting. Study design will be a longitudinal evaluation of errors early after implementation and after sustained use.

A Trial of Point of Care Information in Ambulatory Pediatrics

Does presentation of clinical evidence for decision making at point-of-care improve prescribing patterns in ambulatory pediatrics?

Improving Safety By Computerizing Outpatient Prescribing

Patient safety is at the forefront of critical issues in health care. Medications are the single most frequent cause of adverse events, and in the inpatient setting adverse drug events (ADEs) are common, expensive, injurious to patients, and often preventable. Relatively little, however, is known about the frequency of ADEs in the ambulatory setting, how to monitor for outpatient ADEs, or on the impact of prevention strategies such as computerization of prescribing supplemented...

Using Health Information Technology (HIT) to Improve Transitions of Complex Elderly Patients From Skilled Nursing Facility (SNF) to Home

The incidence of drug-induced injury is high in the ambulatory geriatric population, especially for elders with complex healthcare needs during high risk transitions to the ambulatory setting. In a previous study funded by the National Institute on Aging and the Agency for Healthcare Research and Quality [AHRQ] (AG 15979), the investigators determined that drug-related injuries occur at a rate of more than 50 per 1000-patient years in older adults in the ambulatory setting and...

Multifaceted Intervention to Improve Prescribing in Patients With Chronic Kidney Disease

In 2001, an estimated 1.9 million Canadians had chronic renal disease and the number of patients being treated for end stage renal disease climbed by nearly 20% in 5 years. Many medications commonly used in elderly patients are excreted by the kidney. Failure to adjust doses in those with impaired renal function can result in medication overdose, leading to potentially serious morbidity and mortality. Studies in hospitals and long term care facilities have found a 19-67% ra...

Reducing the Unnecessary Use of Heavily Marketed Medications: A Randomized Controlled Trial

Prescribing decisions by clinicians are often thought to be simple: a patient's clinical problem leads a prescriber to choose the optimal treatment. However, many factors other than the patient's condition affect prescribing decisions, including the marketing of pharmaceuticals. Clinicians are subjected to direct "detailing" by representatives of the pharmaceutical industry, advertisements in medical journals and requests for specific treatments from patients, who are increas...

Assessment of an Electronic Voting System Within the Tutorial Setting. A Randomised Controlled Trial

A study of an electronic voting system as a learning aid during tutorials

Improving Safety by Basic Computerizing Outpatient Prescribing

The study will measure the effect of basic clinical decision support on medical errors and adverse drug events in the ambulatory setting.

Computer-Based Decision Support in Managing Asthma in Primary Care

Asthma is a health problem that afflicts many Canadians. Better methods are needed to provide primary care physicians with ways of implementing current guidelines into regular practice for optimal disease management. This study will test the benefits of providing computer-based decision-support for asthma to primary care physicians, with links to home monitoring for their patients. To add value and to ensure regular use for the physician for all of his/her patients, these compu...

Rural Alberta Clinical Trial in Optimizing Hypertension

The purpose of this study is to evaluate the effect of enhanced pharmacist care (patient identification, assessment, education, prescribing/titration of antihypertensive medications and close follow-up) on systolic blood pressure (BP) reduction in patients with poorly controlled hypertension in the rural setting.

Using Clinical Alerts to Decrease Inappropriate Medication Prescribing

Introduction: The Beers list identifies medications that should be avoided in persons 65 years or older because they are ineffective, pose an unnecessarily high risk, or a safer alternative is available. In a recent study, we found a high rate of prescribing of Beers list medications to hospitalized patients. At Baystate, 41% of medical patients received at least one Beers list drug classified as "high severity," meaning it carried a high risk for an adverse drug react...

Taconic Health Information Network and Community (THINC)

The Taconic IPA, a 2,500 physician independent practice association (IPA) located in Fishkill, New York (NY), is involved in an information technology project to improve the quality, safety and efficiency of healthcare in the region. Over the past three years, the organization has worked with area hospitals and laboratories to create a community wide electronic data exchange. Currently, the Taconic IPA is in the midst of implementing a full electronic health record in some p...

A Research Study to Examine Cutaneous Allodynia and Cluster Headache

This is a research study examining cutaneous (q-tan-ee-us) allodynia (all-o-din-ee-uh) and cluster headaches. Cutaneous allodynia means the feeling of pain or unpleasant sensation when normally non-painful stimuli (e.g. light touch) are applied to the skin. Many studies have been performed looking at the presence of cutaneous allodynia in patients with migraine; however, few studies have examined it in cluster headache patients. There is still much to be learned about the brai...

Improving Safety and Quality With Outpatient Order Entry

The purpose of this study is to evaluate the impact of integrating ambulatory computerized physician order entry (ACPOE) and advanced clinical decision support systems (CDSS) on safety and quality domains in the ambulatory setting, including: a) medication monitoring, b) preventive care and chronic disease management, and c) test result follow-up. In addition we will evaluate the impact on organizational efficiency, physician workflow and satisfaction, and perform a cost-benef...

Electronic Feedback on Diabetic Care to General Practitioners

The aim of this study is to determine whether electronic feedback to general practitioners on quality of Type 2-Diabetes care increases the quality of care measured on process and outcome measures contained in the national guidelines. Effect evaluation will be performed using a mixed method design.

European Quality of Care Pathways Study on Proximal Femur Fracture (EQCP-PFF)

Care pathways, a complex intervention to (re)organise, standardize and evaluate care processes, are used worldwide and in different kinds of settings. Although their international use, the impact is unclear. The European Quality of Care Pathways Study is the first international cluster Randomized Controlled Trial on the effect of care pathways for proximal femur fracture patients (PFF). The hypothesis is that teams who work with care pathways for PFF patients deliver care tha...

Improving Antibiotic Use in Acute Care Treatment

Purpose The emergence and rapid rise in antibiotic resistance among common bacteria are adversely affecting the clinical course and health care costs of community-acquired infections. Because antibiotic resistance rates are strongly correlated with antibiotic use patterns, multiple organizations have declared reductions in unnecessary antibiotic use to be critical components of efforts to combat antibiotic resistance. Among humans, the vast majority of unnecessary antibiotic pr...

Safe Passages: Ensuring Quality Transitions From NICU (Neonatal Intensive Care Unit) to Ambulatory Care

Infants born prematurely or with complex congenital abnormalities are surviving to discharge in growing numbers and often require significant monitoring and coordination of care in the ambulatory setting. The specific aims of this project are to determine the effectiveness of a redesigned discharge process that includes a Health Coach and an expanded discharge binder to improve health outcomes in the post discharge follow-up period as compared with usual care. The outcomes to...

European Quality of Care Pathways Study on Chronic Obstructive Pulmonary Disease (COPD)

Care pathways, a complex intervention to (re)organise, standardize and evaluate care processes, are used worldwide and in different kinds of settings. Although their international use, the impact is unclear. The European Quality of Care Pathways Study is the first international cluster Randomized Controlled Trial on the effect of care pathways for COPD patients. The hypothesis is that teams who work with care pathways for COPD patients deliver care that is more complian...

Reducing Transition Drug Risk

Patient transfer between sites of care is regular practice during an episode of care in our current health care system. Yet inter-site transfer is associated with lapses in care quality that adversely affect patient outcomes. A common iatrogenic harm precipitated at the time of transfer is harm from drug prescribing, or adverse drug events (ADEs). In this study we will evaluate a medication reconciliation tool developed to help providers make effective prescribing decisions...

Study of Hypothalamic Metabolism in Spontaneous Cluster Headache Attacks

Cluster headache is characterized by unilateral excruciating head pain and autonomic dysfunction. Hypothalamic overactivity was observed in nitrate-induced cluster-headache and in only one case of spontaneous cluster headache 'Sprenger et al, 2004). This prompted the application of hypothalamic deep brain stimulation. The aim of this data is to precise the localisation of the hypothalamic activation.

Effect of an Integrated Care Pathway on Asthma Care in Hospital

Integrated care pathways (ICP) coalesce medical and nursing work practices, unifying and directing care in line with current best practice and guidelines. We wish to examine the introduction of an ICP for children with wheeze/asthma admitted to our hospital. We will determine whether more rigid, but guided care results in faster recovery, quicker discharge with better education and fewer prescribing errors, but also determine whether staff feel alienated by the rigidity of prac...

Electronic Tool to Record Cancer Symptoms in Patients With Advanced Cancer Receiving Palliative Care

RATIONALE: A hand held electronic tool used to monitor symptoms and assess quality of life may improve communication between patients and their doctors and improve the ability to plan treatment for patients with advanced cancer receiving palliative care. It is not yet known whether symptoms are better controlled with or without use of this electronic tool. PURPOSE: This randomized phase III trial is studying an electronic tool to see how well it records cancer symptoms in pati...

Introduction of the Surgical Safety Checklist

In January of 2007, the World Health Organization's (WHO) World Alliance for Patient Safety initiated a project called "Safe Surgery Saves Lives" to identify minimum standards of surgical care that can be universally applied across countries and settings. Through a two year process involving international input from surgeons, anesthesiologists, nurses, infectious disease specialists, epidemiologists and others, the WHO created a surgical safety checklist that encompasses a simp...

Post Traumatic Stress Disorder Among VA Ambulatory Care Patients

Posttraumatic stress disorder (PTSD) occurs in response to an extreme traumatic stressor. It is estimated that as many as 1 million VA patients who were exposed to combat may have PTSD. VA patients with PTSD recently have been designated as a �Special Emphasis� population for which health care resources are allocated at approximately 14 times those allocated to patients without such chronic, complex, and intensive health care needs (i.e., �Basic Care� groups). Despite...