Improving Laboratory Monitoring in Community Practices: A Randomized Trial

Medication errors and preventable adverse drug events occur commonly among patients in the
ambulatory setting and constitute an important target for patient safety and quality
improvement. Laboratory monitoring to ensure the safety and effectiveness of drug therapy
and the timely management of abnormal results of laboratory testing have been increasingly
recognized as important areas for improving patient safety in ambulatory care. Promising
interventions have been developed for practices affiliated with hospitals and integrated
delivery systems, but efforts to date have not adequately reached physicians practicing solo
or in small practices in the community. The Massachusetts e-Health Collaborative (MAeHC;
www.maehc.org) provides an important opportunity to study implementation of healthcare
information technology innovations in a community setting. In 2007, the MAeHC will complete
the implementation of commercially available electronic health records (EHRs) for 441
physicians in more than 200 office practices in three diverse communities in Massachusetts.
In this group of small-to-medium sized office practices in both urban and rural regions of
the State, we will: 1) identify the barriers to and facilitators of laboratory monitoring
and timely follow-up of abnormal laboratory results, especially for elderly patients and
clinical scenarios common to this population; 2) design, implement and evaluate the
effectiveness of clinical decision support (point-of-care alerts) for laboratory monitoring
in a widely used, commercially available EHR; 3) design, implement and evaluate the
effectiveness of a results management system to improve the timely follow-up of abnormal
laboratory test results in office practice; 4) develop a practical dissemination guide to
assist other practices and communities interested in implementing similar interventions.
The results of this study will be important because they will demonstrate and accelerate the
dissemination of clinicians' use of healthcare information technology to improve patient
safety and healthcare quality beyond integrated delivery systems and should be broadly
generalizable to small- and medium-sized office practices in community settings.

Inclusion Criteria:

- Patients receiving care from clinicians at primary care and adult internal medicine
specialty practices

Exclusion Criteria:

- None