BUFFALO, N.Y -- Medication errors are one of the most serious
problems occurring in doctor's offices and out-patient clinics, and
older persons with chronic conditions are the most vulnerable.
An experimental information technology (IT) intervention
designed to help reduce such errors, developed by Gurdev Singh,
Ph.D., director of the Patient Safety Research Center at the
University at Buffalo, will begin this spring in eight ambulatory
medical offices throughout Western New York.
The study is funded by a $1.2 million, 3-year grant from the
federal Agency for Healthcare Research and Quality. The patient
safety center is part of the Family Medicine Research Institute in
the Department of Family Medicine in the UB School of Medicine and
Physicians and office staff in the eight sites will be assigned
randomly to conduct "business-as-usual" or to implement an IT-based
Team Resource Management (TRM) tool embedded in the ACORN office
quality management system developed by Dendress Corp. of Buffalo,
in collaboration with the center.
Singh, the study's principal investigator, developed the study
in consultation with his research team and Upstate New York
Practice Based Research Network (UNYNET) clinicians who already are
using electronic medical records and were interested in identifying
useful and affordable error-reducing approaches for their
Outcome assessment will be based on medication safety among
geriatric patients and on office staff use of the IT-based
The study will focus on patients 65 or older who are being
treated for cardiovascular disease. The first aim will be to
determine the impact of the intervention on reducing injuries such
as falls or internal bleeding resulting from the use of a drug.
Data will be gathered by reviewing patients' records obtained at
baseline and at 12 months post-baseline.
Secondly, the study team will assess physicians' compliance with
recommended laboratory testing of patients taking specific cardiac
medications: ACE inhibitors or angiotensin receptor blockers (ARBs)
for controlling blood pressure, treating heart failure and
preventing kidney damage in people with hypertension or diabetes;
diuretics; digoxin, a drug used to treat congestive heart failure
and certain heartbeat irregularities, and statins for lowering
The chart review for this outcome measure will include recording
whether the medication was prescribed (for at least 6 months during
the preceding 12 months), whether the recommended lab test was
ordered (at least once during the measurement year) and whether the
lab results were recorded in the patient's chart.
The final aim of the study will be to determine if the IT tool
is practical in a primary-care office setting and if it is embraced
by office staff.
This demonstration project will provide pilot data for a larger
study on the usefulness of the specific IT software.
The University at Buffalo is a premier research-intensive
public university, the largest and most comprehensive campus in the
State University of New York. UB's more than 28,000 students pursue
their academic interests through more than 300 undergraduate,
graduate and professional degree programs. The School of Medicine
and Biomedical Sciences, School of Dental Medicine, School of
Nursing, School of Pharmacy and Pharmaceutical Sciences and School
of Public Health and Health Professions are the five schools that
constitute UB's Academic Health Center. Founded in 1846, the
University at Buffalo is a member of the Association of American