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

OBJECTIVES

To develop order entry algorithms for five common nursing home problems and to test their acceptance, use, and preliminary effect on nine quality indicators and resource utilization.

DESIGN

Pre-post, quasi-experimental study.

SETTING

Two Department of Veterans Affairs nursing homes.

PARTICIPANTS

Randomly selected residents (N=265) with one or more target conditions and 42 nursing home providers.

INTERVENTION: Expert panels developed computerized order entry algorithms based on clinical practice guidelines. Each was displayed on a single screen and included an array of diagnostic and treatment options and means to communicate with the interdisciplinary team.

MEASUREMENTS: Medical records were abstracted for the 6 months before and after deployment for quality indicators and resource utilization.

RESULTS

Despite positive provider attitudes toward the computerized order entry algorithms, their use was infrequent and varied according to condition: falls (73.0%), fever (9.0%), pneumonia (8.0%), urinary tract infection (7.0%), and osteoporosis (3.0%). In subjects with falls, trends for improvements in quality measures were observed for six of the nine measures: measuring orthostatic blood pressure (17.5-30.0%, P=.29), reducing neuroleptics (53.8-75.0%, P=.27), reducing sedative-hypnotics (16.7-50.0%, P=.50), prescription of calcium (22.5-32.5%, P=.45), vitamin D (20.0-35.0%, P=.21), and external hip protectors (25.0-47.5%, P=.06). Little improvement was observed in the other conditions (documentation of vital signs, physical therapy referrals, or reduction of benzodiazepines or antidepressants). There was no change in resource utilization.

CONCLUSION

Computerized order entry algorithms were used infrequently, except for falls. Further study may determine whether their use leads to improved care.