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Article
Strategies for detecting adverse drug events among older persons in the ambulatory setting
Open Access Articles
  • Terry S. Field, University of Massachusetts Medical School
  • Jerry H. Gurwitz, University of Massachusetts Medical School
  • Leslie R. Harrold, University of Massachusetts Medical School
  • Jeffrey M. Rothschild, Harvard Medical School
  • Kristin R. DeBellis, University of Massachusetts Medical School
  • Andrew C. Seger, University of Massachusetts Medical School
  • Leslie S. Fish, University of Massachusetts Medical School
  • Lawrence D. Garber, University of Massachusetts Medical School
  • Michael Kelleher, University of Massachusetts Medical School
  • David W. Bates, Harvard Medical School
UMMS Affiliation
Meyers Primary Care Institute
Publication Date
11-1-2004
Document Type
Article
Subjects
*Adverse Drug Reaction Reporting Systems; Aged; Ambulatory Care Facilities; Drug Toxicity; Humans; Medical Records; Medicare; Medication Errors; New England; Pharmaceutical Preparations
Abstract
OBJECTIVE: To examine various strategies for the identification of adverse drug events (ADEs) among older persons in the ambulatory clinical setting. DESIGN: A cohort study of Medicare enrollees (n = 31,757 per month) receiving medical care from a large multispecialty group practice during a 12-month observation period (July 1, 1999 through June 30, 2000). MEASUREMENTS: Possible drug-related incidents occurring in the ambulatory clinical setting were detected using signals from multiple sources. RESULTS: During the tracking period, there were 1,523 identified ADEs, of which 421 (28%) were considered preventable. Across all sources, 23,917 signals were found; 12,791 (53%) were potential incidents that led to review of a patient's medical record and 2,266 (9%) were presented to physician reviewers. Although the positive predictive value (PPV) for reports from providers was high compared with other sources (54%), only 11% of the ADEs and 6% of the preventable ADEs were identified through this source. PPVs for other sources ranged from a low of 4% for administrative incident reports to a high of 12% for free-text review of electronic notes. Computer-generated signals were the source for 31% of the ADEs and 37% of the preventable ADEs. Electronic notes were the source for 39% of the ADEs and 29% of the preventable ADEs. There was little overlap in the ADEs identified across all sources. CONCLUSION: Our findings emphasize the limitations of voluntary reporting by health care providers as the principal means for detection of ADEs and suggest that multiple strategies are required to detect ADEs in geriatric ambulatory patients.
DOI of Published Version
10.1197/jamia.M1586
Source
J Am Med Inform Assoc. 2004 Nov-Dec;11(6):492-8. Epub 2004 Aug 6. Link to article on publisher's site
Comments

Citation: J Am Med Inform Assoc. 2004 Nov-Dec;11(6):492-8. Epub 2004 Aug 6. Link to article on publisher's site

Related Resources
Link to Article in PubMed
PubMed ID
15299000
Citation Information
Terry S. Field, Jerry H. Gurwitz, Leslie R. Harrold, Jeffrey M. Rothschild, et al.. "Strategies for detecting adverse drug events among older persons in the ambulatory setting" Vol. 11 Iss. 6 (2004) ISSN: 1067-5027 (Print)
Available at: http://works.bepress.com/lawrence_garber/2/