About CERTs
Annual Report Year 3
CERTs Progress
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HMO Research Network—
Collaboration and the Big Picture of Prescribing Safety
The HMO Research Network CERTs comprises the investigators, information resources, delivery systems, and members of 10 HMOs across the country committed to public domain research. The center emphasizes studies of the use and outcomes of therapeutics in large, defined populations, and of methods for changing provider and patient behavior regarding prescribing and adherence to therapy. The research typically involves multiple HMOs to achieve a large, diverse population and range of delivery systems that result in easily applicable findings.
Key projects:
- A study to assess and ultimately reduce misuse of antibiotics in children
- Assessment of the incidence of Churg-Strauss syndrome, a rare form of inflammation of blood vessels, to determine if the use of certain asthma medications is more common among these patients
- Evaluation of patient preferences for communicating medication errors
The HMO Research Network CERTs presents a unique array of resources. Made up of 10 HMOs across the country, each with experienced investigators committed to public domain research, the center has access to a large, diverse, and well-defined patient population, as well as the clinicians who care for them and the supporting information systems. The HMOs have over 16,000 care providers, who treat 7 million patients. Their research benefits from a “real world” clinical setting plus the statistical power of large study populations.
The HMO CERTs is leading an ambitious drug safety program that includes all seven of the CERTs centers. Until now, most work on drug safety has focused on the inpatient setting. However, far more prescribing is done for outpatients, and it is into this vast and relatively uncharted territory that the HMO Network can lead the way. Identifying the most important errors in this largely unexamined setting in order to develop methods for preventing them is a necessary first step. These two aims, identification and prevention, are the subjects of the largest federal patient safety grant awarded in the past year—the CERTs Prescribing Safety Program, awarded to the HMO Research Network CERTs.
“These HMOs are an ideal environment in which to learn how to improve care, both for their own members and for others as well,” said Dr. Richard Platt of Harvard Medical School and Harvard Pilgrim Healthcare, principal investigator of the HMO Research Network CERTs and of the CERTs Prescribing Safety Program.
The project will characterize the frequency and severity of medication errors, focusing on the most commonly misused drugs, those with especially strong warnings against misuse, and on medication errors in vulnerable populations, such as children and the elderly.
“Nothing has the potential to improve the health of our nation more than evidence-based medicine. Our collaboration with the CERTs is one of the most productive ways to promote an evidence-based system. Programs like the safety initiative being conducted in the health plans of the HMO Research Network CERTs demonstrate the leadership of the health plan community to improve America's health care system.”
—Karen Ignagni, President and CEO,
American Association of Health Plans
Analyzing the HMOs' data, the researchers will evaluate how often medicines are prescribed outside FDA “black box” warnings, extremely strong cautions added to prescribing information when a serious potential adverse effect is noted in a medicine's use. Other commonly accepted safety guidelines and input from the expert advisory committee will be used as benchmarks as well.
Once the investigators have determined the frequency and severity of these medication errors, they will implement three educational interventions and measure their impact by reviewing the records again afterwards.
Two of the interventions based on this project's research are experiments with electronic prescription order entry, which will give physicians informed assistance in making medication choices and help reduce errors in dosing. These also include ongoing outreach to the physician users to further refine the power of these systems. The third intervention will use a randomized trial design to assess the effects of group physician education.
This is the first independently funded project that involves all of the CERTs, with each of the seven centers represented on the advisory committee. This not only ensures expert opinion from a variety of sources, but also provides timely access to investigators whose expertise may be perfectly suited to further studies arising from these research findings.
Other centers are leading parts of the research. The Duke CERTs, with its experience in cardiology, will pay particular attention to drugs that prolong the QT-interval and may create dangerous heart arrhythmias.
The UNC CERTs, true to its mission of improving therapeutics for children, is playing a leading role in defining the problems specific to prescribing medicines to young patients.
The CERTs model of collaboration and public-private partnership creates an environment conducive to solving problems beyond the reach of any individual center. This approach uses the unique resources of each element of the CERTs to contribute knowledge towards a generalized solution that can be tested in the variety of practice settings represented by the CERTs network.