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Improving appropriateness of acid‐suppressive medication use via computerized clinical decision support
Author(s) -
Herzig Shoshana J.,
Guess Jamey R.,
Feinbloom David B.,
Adra May,
Afonso Kevin A.,
Howell Michael D.,
Marcantonio Edward R.
Publication year - 2015
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.2260
Subject(s) - medicine , stress ulcer , hospital medicine , intervention (counseling) , intensive care medicine , emergency medicine , interrupted time series analysis , clinical decision support system , medline , intensive care unit , health care , nursing , statistics , mathematics , political science , law , economics , economic growth
As part of the Choosing Wisely Campaign, the Society of Hospital Medicine identified reducing inappropriate use of acid‐suppressive medication for stress ulcer prophylaxis as 1 of 5 key opportunities to improve the value of care for hospitalized patients. We designed a computerized clinical decision support intervention to reduce use of acid‐suppressive medication for stress ulcer prophylaxis in hospitalized patients outside of the intensive care unit at an academic medical center. Using quasiexperimental interrupted time series analysis, we found that the decision support intervention resulted in a significant reduction in use of acid‐suppressive medication with stress ulcer prophylaxis selected as the only indication, a nonsignificant reduction in overall use, and no change in use on discharge. We found low rates of use of acid‐suppressive medication for the purpose of stress ulcer prophylaxis even before the intervention, and continuing preadmission medication was the most commonly selected indication throughout the study. Our results suggest that attention should be focused on both the inpatient and outpatient settings when designing future initiatives to improve the appropriateness of acid‐suppressive medication use. Journal of Hospital Medicine 2015;10:41–45. © 2015 Society of Hospital Medicine