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Handler, Steven Mark (2010) DETECTING ADVERSE DRUG REACTIONS IN THE NURSING HOME SETTING USING A CLINICAL EVENT MONITOR. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Adverse drug reactions (ADRs) are the most clinically significant and costly medication-related problems in nursing homes (NH), and are associated with an estimated 93,000 deaths a year and as much as $4 billion of excess healthcare expenditures. Current ADR detection and management strategies that rely on pharmacist retrospective chart reviews (i.e., usual care) are inadequate. Active medication monitoring systems, such as clinical event monitors, are recommended by many safety organizations as an alternative to detect and manage ADRs. These systems have been shown to be less expensive, faster, and identify ADRs not normally detected by clinicians in the hospital setting. The main research goal of this dissertation is to review the rationale for the development and subsequent evaluation of an active medication monitoring system to automate the detection of ADRs in the NH setting. This dissertation includes three parts and each part has its own emphasis and methodology centered on the main topic of better understanding of how to detect ADRs in the NH setting.The first paper describes a systematic review of pharmacy and laboratory signals used by clinical event monitors to detect ADRs in hospitalized adult patients. The second paper describes the development of a consensus list of agreed upon laboratory, pharmacy, and Minimum Data Set signals that can be used by a clinical event monitor to detect potential ADRs. The third paper describes the implementation and pharmacist evaluation of a clinical event monitor using the signals developed by consensus.The findings in the papers described will help us to better understand, design, and evaluate active medication monitoring systems to automate the detection of ADRs in the NH setting. Future research is needed to determine if NH patients managed by physicians who receive active medication monitoring alerts have more ADRs detected, have a faster ADR management response time, and result in more cost-savings from a societal perspective, compared to usual care.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Handler, Steven Markhandler@pitt.eduHANDLER
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairBecich, Michaelbecich@pitt.eduBECICH
Committee MemberHanlon, Josephjth14@pitt.eduJTH14
Committee MemberCastle, Nicholascastlen@pitt.eduCASTLEN
Committee MemberVisweswaran, Shyamshv3@pitt.eduSHV3
Committee MemberChapman, Wendy Wwec6@pitt.eduWEC6
Date: 18 May 2010
Date Type: Completion
Defense Date: 6 January 2010
Approval Date: 18 May 2010
Submission Date: 29 September 2009
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Institution: University of Pittsburgh
Schools and Programs: School of Medicine > Biomedical Informatics
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: adverse drug event; adverse drug reaction; adverse drug reaction reporting systems; clinical event monitor; clinical pharmacy information system; computer generated signals; decision support system; drug monitoring; clinical decisions support systems; clinical laboratory information systems
Other ID:, etd-09292009-123835
Date Deposited: 10 Nov 2011 20:02
Last Modified: 15 Nov 2016 13:50


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