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A randomized evaluation of a computer-based physician's workstation: design considerations and baseline results
B L Rotman1, A N Sullivan, T McDonald
1Department of Veterans Affairs Medical Center, Palo Alto, CA, USA.
Proceedings. Symposium on Computer Applications in Medical Care
|January 1, 1995
Summary
This study evaluated a Physician's Workstation (PWS) for ambulatory care. Baseline analysis of drug costs and interactions informed the design of a randomized controlled trial to optimize clinical information system evaluation.
Area of Science:
- Health Informatics
- Clinical Trial Design
- Ambulatory Care
Background:
- Physician's Workstation (PWS) is an ambulatory care information system.
- The General Medical Clinic (GMC) at Palo Alto VA is the study setting.
- Evaluating new clinical information systems requires robust experimental design.
Purpose of the Study:
- To select appropriate outcome variables for a randomized controlled trial of PWS.
- To develop a statistically powerful experimental design for a limited number of subjects.
- To assess the impact of PWS on drug costs and drug-drug interactions.
Main Methods:
- Retrospective analysis of drug costs and drug-drug interactions.
- Calculation of mean daily drug cost per physician per patient.
- Determination of the rate of major drug-drug interactions per prescription.
Main Results:
- Mean daily drug cost was 99.3 cents (+/- 13.4 cents).
- The rate of major drug-drug interactions was 2.9% (+/- 1%).
- A two-period parallel design was selected for the trial.
Conclusions:
- Baseline data on drug costs and interactions are crucial for designing clinical information system trials.
- The selected trial design maximizes statistical power and minimizes bias.
- This approach enables efficient evaluation of ambulatory care information systems like PWS.