Strategies for Detecting Adverse Drug Events among Older Persons in the Ambulatory Setting

• DOI: 10.1197/jamia.m1586
• Publication Date: 2004-08-07T00:13:41Z
• Authors: Terry S. Field; Jerry H. Gurwitz; Leslie R. Harrold; Jeffrey M. Rothsc...; Kristin Debellis; Andrew C. Seger; Leslie S. Fish; Lawrence Garber; Michael Kelleher; David W. Bates
• Keywords: Adverse drug event; Clinical Practice

To examine various strategies for the identification of adverse drug events (ADEs) among older persons in ambulatory clinical setting.A cohort study Medicare enrollees (n = 31,757 per month) receiving medical care from a large multispecialty group practice during 12-month observation period (July 1, 1999 through June 30, 2000).Possible drug-related incidents occurring setting were detected using signals multiple sources.During tracking period, there 1,523 identified ADEs, which 421 (28%) considered preventable. Across all sources, 23,917 found; 12,791 (53%) potential that led to review patient's record and 2,266 (9%) presented physician reviewers. Although positive predictive value (PPV) reports providers was high compared with other sources (54%), only 11% ADEs 6% preventable this source. PPVs ranged low 4% administrative incident 12% free-text electronic notes. Computer-generated source 31% 37% ADEs. Electronic notes 39% 29% There little overlap across sources.Our findings emphasize limitations voluntary reporting by health as principal means detection suggest are required detect geriatric patients.