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American Journal of Health-System Pharmacy, Vol. 67, Issue 8, 613-620
Copyright © 2010 by American Society of Health-System Pharmacists
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Practice Report

Effects of an adverse-drug-event alert system on cost and quality outcomes in community hospitals

 Frank Piontek, Rajiv Kohli, Paul Conlon, Jeffrey J. Ellis, Jason Jablonski and Narendra Kini

FRANK PIONTEK, M.A., is Healthcare Informatics Consultant, Trinity Health, Novi, MI. RAJIV KOHLI, PH.D., is Associate Professor of Management Information Systems, College of William and Mary, Williamsburg, VA. PAUL CONLON, PHARM.D., J.D., is Senior Vice President, Clinical Quality and Patient Safety; and JEFFREY J. ELLIS, PHARM.D., M.S., BCPS, is Pharmacy Clinical Operations Director, Trinity Health. JASON JABLONSKI, B.S.PHARM., is Director of Pharmacy, Respiratory Therapy, Sleep Disorders Center, and Neurodiagnostics, St. Joseph Regional Medical Center, South Bend, IN. NARENDRA KINI, M.D., M.H.A., is President and Chief Executive Officer, Miami Children’s Hospital, Miami, FL

Address correspondence to Dr. Ellis at Trinity Health, 27870 Cabot Drive, Novi, MI 48377 (ellisjej{at}trinity-health.org).


Purpose. The effects of an adverse-drug-event (ADE) alert system on cost and quality outcomes in community hospitals were evaluated.

Methods. This retrospective observational study evaluated the effects of an ADE alert system in seven hospitals in the Trinity Health network. Outcomes for all inpatients admitted to these hospitals after and one year before the deployment of an ADE alert system were evaluated. Inpatients in two network hospitals that lacked any computerized ADE alert system constituted the external control group. Administrative data were gathered for patients from these facilities for the same time frames as for the preimplementation and postimplementation groups. Primary outcomes evaluated included pharmacy department costs, variable drug costs, and mortality rates. Secondary outcomes included total hospitalization costs, length of hospital stay (LOS), rate of readmission, and case-mix index. Mean differences in primary and secondary outcome measures across all four groups were examined using analysis of variance.

Results. Significant decreases in mean pharmacy department costs per patient were observed from preimplementation to postimplementation (p < 0.001), while pharmacy department costs increased significantly in the external control group (p = 0.029). Drug costs decreased significantly from baseline (p < 0.001) in the postimplementation group. Drug costs increased significantly in the external control group (p = 0.029). Severity-adjusted mortality rates and LOS decreased significantly in the postimplementation group. Total patient hospitalization costs, both crude and severity adjusted, significantly increased in both groups.

Conclusion. Implementation of an ADE alert system in seven community hospitals demonstrated significant decreases in pharmacy department costs, variable drug costs, and severity-adjusted mortality rates.

Index terms: Computers; Costs; Drugs; adverse reactions; Economics; Hospitals; Mortality; Outcomes; Pharmacy; institutional; hospital; Quality assurance

 

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