Immediate financial impact of computerized clinical decision support for long-term care residents with renal insufficiency: a case study
- Sujha Subramanian1,
- Sonja Hoover1,
- Joann L Wagner2,
- Jennifer L Donovan3,
- Abir O Kanaan3,
- Paula A Rochon4,
- Jerry H Gurwitz2,
- Terry S Field2
- 1RTI International, Waltham, Massachusetts, USA
- 2Meyers Primary Care Institute, University of Massachusetts Medical School, Reliant Medical Group, and Fallon Community Health Plan, Worcester, Massachusetts, USA
- 3Massachusetts College of Pharmacy and Health Sciences, Worcester, Meyers Primary Care Institute, Worcester, Massachusetts, USA
- 4Women's College Hospital, Toronto, Canada
- Correspondence to Terry S Field, Meyers Primary Care Institute, 630 Plantation Street, Worcester, MA 01605, USA;
Contributors SS, JHG, and TSF collaborated in designing the study, interpreting the results, and preparing the manuscript. SH, JLW, JLD, and AOK all assisted with data acquisition and analysis. PAR facilitated acquisition of data and interpreting the results.
- Received 11 February 2011
- Accepted 16 October 2011
- Published Online First 18 November 2011
In a randomized trial of a clinical decision support system for drug prescribing for residents with renal insufficiency in a large long-term care facility, analyses were conducted to estimate the system's immediate, direct financial impact. We determined the costs that would have been incurred if drug orders that triggered the alert system had actually been completed compared to the costs of the final submitted orders and then compared intervention units to control units. The costs incurred by additional laboratory testing that resulted from alerts were also estimated. Drug orders were conservatively assigned a duration of 30 days of use for a chronic drug and 10 days for antibiotics. It was determined that there were modest reductions in drug costs, partially offset by an increase in laboratory-related costs. Overall, there was a reduction in direct costs (US$1391.43, net 7.6% reduction). However, sensitivity analyses based on alternative estimates of duration of drug use suggested a reduction as high as US$7998.33 if orders for non-antibiotic drugs were assumed to be continued for 180 days. The authors conclude that the immediate and direct financial impact of a clinical decision support system for medication ordering for residents with renal insufficiency is modest and that the primary motivation for such efforts must be to improve the quality and safety of medication ordering.
- Economicsquality of care
- care coordination
- health communication
The sponsor was not directly involved in the design, methods, subject recruitment, data collections, analysis, and preparation of manuscript.
Funding This project was supported by grants from the Agency for Healthcare Research and Quality (HS010481 and HS15430).
Competing interests None.
Ethics approval University of Massachusetts Medical School.
Provenance and peer review Not commissioned; externally peer reviewed.