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Research Abstracts Online
January 2008 - March 2009

University of Minnesota Twin Cities
School of Public Health
Division of Health Policy and Management

PI: Jeffrey S. McCullough

The Welfare Consequences of Direct-to-Consumer Advertising; The Effect of Computerized Physician Order Entry and Complementary Organizations Inputs on Quality

This researcher is using MSI resources for two projects. The first studies the clinical and economic consequences of direct-to-consumer advertising (DTCA). This project is an innovative and multidisciplinary approach to measure the clinical and economic consequences of statin advertising for the US population. It employs a novel dataset derived from the electronic medical records of more than 300,000 patients during 1998-2004. Econometric techniques will be used to model the effect of advertisements on statin prescribing, then these measures of effect will be input into a decision-analytic model. This model will project the clinical and economic consequences of varying statin prescribing behavior with DTCA for patients with different cardiac risk levels. Finally, the population-wide effects of statin-related DCTA will be calculated using nationally representative data.

The specific aims of the project are: model the effect of advertising on statin prescribing behavior for patients with different clinical risks; quantify the effect of advertising-induced statin prescriptions on clinical and economic outcomes; and match the observations to a nationally representative sample to calculate advertising’s overall societal impact.

The second project investigates the use of health information technology to reduce clinical errors in hospitals. Computerized physician order entry (CPOE) systems may remedy communication problems while facilitating clinical guideline implementation. CPOE also captures information for both clinical and management purposes. Numerous case studies have documented successful CPOE implementations.

Effective CPOE implementation is not as simple as installing hardware and software; rather, hospitals must make complementary technological and organizational investments. CPOE must interoperate with electronic medical record and medication administration record systems. These technologies must also penetrate the organization, providing access to staff throughout the hospital. Finally, physicians must invest their own time to learn and use health information technology (HIT).

This project measures the effect of HIT on both quality and costs. The effect of HIT and its organizational complements on medical errors will be measured, and those measures will be combined with previous research deriving the financial cost of medical errors; thus, the financial value of CPOE-drive errors reductions can be estimated. Also, the projects employs identification tests based on different patient safety outcomes that should and should not be affected by HIT. Overall, this study will provide new insight into how HIT creates both financial and clinical value while enhancing the empirical rigor with which that value is measured.