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Methodology for Establishing a Community-Wide Life Laboratory for Capturing Unobtrusive and Continuous Remote Activity and Health Data

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Published on: July 27, 2018

Development and pilot testing of computerized order entry algorithms for geriatric problems in nursing homes.

Cathleen S Colón-Emeric¹, Kenneth E Schmader, Jack Twersky

¹Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA. colon001@mc.duke.edu

Journal of the American Geriatrics Society

|August 18, 2009

Summary

Computerized order entry algorithms were rarely used in nursing homes, except for fall prevention. Further research is needed to determine if these tools improve patient care quality.

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Area of Science:

Gerontology
Health Informatics
Quality Improvement

Background:

Nursing home care faces challenges in standardizing treatment for common conditions.
Clinical practice guidelines exist but are not always consistently applied.
Order entry systems can potentially improve care consistency.

Purpose of the Study:

To develop and evaluate computerized order entry algorithms for five common nursing home problems.
To assess the acceptance, utilization, and impact of these algorithms on quality indicators and resource use.

Main Methods:

A pre-post, quasi-experimental study was conducted in two Department of Veterans Affairs nursing homes.
Computerized order entry algorithms were developed by expert panels based on clinical guidelines.
Data on quality indicators and resource utilization were collected for 265 residents before and after algorithm implementation.

Main Results:

Provider acceptance was positive, but algorithm use was infrequent and condition-dependent (falls: 73.0%, others <10%).
Trends toward improved quality measures were observed for fall-related interventions (e.g., orthostatic blood pressure, medication reduction).
No significant changes in resource utilization were noted, and improvements in other conditions were minimal.

Conclusions:

Computerized order entry algorithms demonstrated low utilization in nursing homes, with the exception of fall management.
The study suggests a need for further investigation into factors influencing adoption and the ultimate impact on patient care outcomes.