Enabling Shared Decision Making to Reduce Harm from Drug Interactions: An End-to-End Demonstration (Utah)

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Although drug-drug interactions (DDIs) are preventable, they still persist, accounting for 5 to 14 percent of adverse drug reactions (ADRs) in hospitalized patients and up to 3 percent of elderly ambulatory patients. Unfortunately, the adoption of clinical decision support (CDS) tools that utilize DDI drug checking has not solved the issue, with alerts overridden up to 90 percent of the time. Although patients could play a crucial role in preventing harm due to DDIs, they are not currently engaged in shared decision making regarding many DDI risks.

This research will help move DDI CDS beyond physician-centric decision making to patient-centered shared decision making using interactive decision dashboards. Dashboards graphically communicate risks and decision options, allowing patients and clinicians to deliberate together about the advantages and disadvantages of different therapies to arrive at decisions that are concordant with both clinicians’ knowledge and patients’ preferences.

The specific aims of the research are as follows:

  • Design and evaluate a user-centered DDI CDS dashboard called DDInteract. 
  • Enable the creation of contextual DDI CDS knowledge artifacts using CDS Connect. 
  • Conduct a pilot dissemination of DDInteract and DDI knowledge process. 

This research will utilize the AHRQ CDS Connect authoring tool, Clinical Query Language (CQL), and Fast Healthcare Interoperability Resources (FHIR) standards. Two frequently occurring and clinically significant DDIs will be used: 1) warfarin and non-steroidal anti-inflammatory drugs, and 2) direct-acting oral anticoagulants and serotonin-inhibiting antidepressants.

The researchers anticipate that patients will value and benefit from having risk information presented in real time to allow them to make more informed decisions about their care, as patients and providers jointly determine the most appropriate actions regarding medication management to mitigate harm.

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