Difference between revisions of "Cost-Effectiveness of a Computerized Provider Order Entry System in Improving Medication Safety Ambulatory Care"

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== Abstract ==
 
== Abstract ==
  
*BACKGROUND:
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*Background—Computerized provider order entry (CPOE) is the process of entering physician
Computerized provider order entry ([[CPOE]]) with clinical decision support is a basic criterion for hospitals' meaningful use of electronic health record systems. A study was conducted to evaluate from the societal perspective the cost-utility of implementing [[CPOE]] in acute care hospitals in the United States.
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orders directly into an electronic health record. Although CPOE has been shown to improve
*METHODS:
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medication safety and reduce health care costs, these improvements have been demonstrated
A decision-analytical model compared CPOE with paper ordering among patients admitted to acute care hospitals with >25 beds. Parameters included start-up and maintenance costs, as well as costs for provider time use, medication and laboratory test ordering, and preventable adverse drug events. Probabilistic analyses produced incremental costs, effectiveness, and cost-effectiveness ratios for hospitals in four bed-size categories (25-72, 72-141, 141-267, 267-2,249).
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largely in the inpatient setting; the cost-effectiveness in the ambulatory setting remains uncertain.
*RESULTS:
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*Objective—The objective was to estimate the cost-effectiveness of CPOE in reducing
Relative to paper ordering and using typical estimates of implementation costs, CPOE had, on average, >99% probability of yielding savings to society and improving health. Per hospital in each size category, mean life-time savings -in millions-were $11.6 (standard deviation, $9.30), $34.4 ($21.2), $71.8 ($43.8), and $170 ($119) (2012 dollars), respectively, and quality-adjusted life-years (QALYs) gained were 19.9 (16.9), 53.7 (38.7), 109 (79.6), and 249 (205). Incremental effectiveness and costs were less favorable in certain circumstances, such as high implementation costs. Nationwide, anticipated increases in CPOE implementation from 2009 through 2015 could save $133 billion and 201,000 QALYs.
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medication errors and adverse drug events (ADEs) in the ambulatory setting.
*CONCLUSIONS:
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*Methods—We created a decision-analytic model to estimate the cost-effectiveness of CPOE in a
In addition to improving health, implementing CPOE with clinical decision support could yield substantial long-term savings to society in the United States, although results for individual hospitals are likely to vary.
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midsized (400 providers) multidisciplinary medical group over a 5-year time horizon— 2010 to
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2014— the time frame during which health systems are implementing CPOE to meet Meaningful
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Use criteria. We adopted the medical group’s perspective and utilized their costs, changes in
 +
efficiency, and actual number of medication errors and ADEs. One-way and probabilistic
 +
sensitivity analyses were conducted. Scenario analyses were explored.
 +
*Results—In the base case, CPOE dominated paper prescribing, that is, CPOE cost $18 million
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less than paper prescribing, and was associated with 1.5 million and 14,500 fewer medication
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errors and ADEs, respectively, over 5 years. In the scenario that reflected a practice group of five
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providers, CPOE cost $265,000 less than paper prescribing, was associated with 3875 and 39
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fewer medication errors and ADEs, respectively, over 5 years, and was dominant in 80% of the
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simulations.
  
 
== Background ==
 
== Background ==
  
 +
The authors seek to evaluate the cost-effectiveness of CPOE implementation in an ambulatory setting by constructing an analytic model. 
  
  
 
== Methods ==
 
== Methods ==
  
 
+
A cost-effectiveness model was constructed by projecting the expected cost savings from decreased ADE's and medication errors, over an expected 5-year run cycle. Total group analysis was based on the entire group of 400 prescribers, small-group analysis was also performed.
  
 
== Results ==
 
== Results ==
  
 +
The "base model" projected  $18 million in savings with CPOE, and would be associated with 1.5 million fewer errors and 14,500 fewer ADEs.  In a small, 5-provider model, the projection was that CPOE would save $265,000 and
 +
result in 3,875 fewer medication errors and 39 fewer ADEs over a 5-year span. 
  
 
== Conclusion ==
 
== Conclusion ==
 +
 +
  
  

Revision as of 02:55, 9 November 2015

This is a review of the 2014 paper by Forrester, et al. [1]


Abstract

  • Background—Computerized provider order entry (CPOE) is the process of entering physician

orders directly into an electronic health record. Although CPOE has been shown to improve medication safety and reduce health care costs, these improvements have been demonstrated largely in the inpatient setting; the cost-effectiveness in the ambulatory setting remains uncertain.

  • Objective—The objective was to estimate the cost-effectiveness of CPOE in reducing

medication errors and adverse drug events (ADEs) in the ambulatory setting.

  • Methods—We created a decision-analytic model to estimate the cost-effectiveness of CPOE in a

midsized (400 providers) multidisciplinary medical group over a 5-year time horizon— 2010 to 2014— the time frame during which health systems are implementing CPOE to meet Meaningful Use criteria. We adopted the medical group’s perspective and utilized their costs, changes in efficiency, and actual number of medication errors and ADEs. One-way and probabilistic sensitivity analyses were conducted. Scenario analyses were explored.

  • Results—In the base case, CPOE dominated paper prescribing, that is, CPOE cost $18 million

less than paper prescribing, and was associated with 1.5 million and 14,500 fewer medication errors and ADEs, respectively, over 5 years. In the scenario that reflected a practice group of five providers, CPOE cost $265,000 less than paper prescribing, was associated with 3875 and 39 fewer medication errors and ADEs, respectively, over 5 years, and was dominant in 80% of the simulations.

Background

The authors seek to evaluate the cost-effectiveness of CPOE implementation in an ambulatory setting by constructing an analytic model.


Methods

A cost-effectiveness model was constructed by projecting the expected cost savings from decreased ADE's and medication errors, over an expected 5-year run cycle. Total group analysis was based on the entire group of 400 prescribers, small-group analysis was also performed.

Results

The "base model" projected $18 million in savings with CPOE, and would be associated with 1.5 million fewer errors and 14,500 fewer ADEs. In a small, 5-provider model, the projection was that CPOE would save $265,000 and result in 3,875 fewer medication errors and 39 fewer ADEs over a 5-year span.

Conclusion

Comments

References

  1. Forrester, S. H., Hepp, Z., Roth, J. A., Wirtz, H. S., & Devine, E. B. (2014). Cost-effectiveness of a computerized provider order entry system in improving medication safety ambulatory care. Value in Health: The Journal of the International Society for Pharmacoeconomics and Outcomes Research, 17(4), 340–349. http://doi.org/10.1016/j.jval.2014.01.009