This renewal application for the HMO Research Network Center for Education and Research in Therapeutics (CERT) continues this CERT's focus on """"""""Studies of therapeutics' use, safety, and effectiveness, using health plans' defined populations, providers, delivery systems, and data."""""""" The CERT will grow to ten HMOs with nearly 11 million members. The CERT will use its products, including a new approach to multi-center studies, datasets, analytical tools, and intervention capabilities to support new studies. This CERT will also continue to use leveraged funding, exceeding $18 million, as well as ongoing partnerships with AHRQ's Patient Safety Initiative, FDA, NIH, CDC, the American Association of Health Plans, other CERTs, and industry. Past and current work includes assessing adverse drug events under specific conditions, and in populations of actual use; describing widespread, potentially unsafe drug use by vulnerable populations (pregnant women, children, and the elderly); studying appropriateness of drug use (antibiotics in children); and the impact of increasing co-payment requirements on diabetes control. This Center is conducting randomized trials to improve use of computerized physician order entry (CPOE) and other methods to enhance safe prescribing. With AAHP, the applicant has created a public website of interventions proven to improve drug use in managed care settings. The application proposes eight new initiatives: 1) develop new methods for discovery of adverse drug reactions (with FDA and CDC); 2) monitor unsafe prescribing practices; 3) test two patient-centered interventions, one to improve adherence to beta-blockers after MI (with the Duke CERT), and another to stimulate initiation of urate lowering therapy for gout (with the UAB CERT); 4) assess medication errors in ambulatory cancer care (with the NIH Cancer Research Network); 5) disseminate patient and physician materials to improve antibiotic use (with AAHP and the Council for Affordable Quality Healthcare); 6) plan a national conference on the impact of managed care drug cost containment policies on outcomes (with AcademyHealth and AAHP); 7) evaluate cost and outcomes using patient safety data; and 8) enhance therapeutics research training. The CERT is also seeking separate support for additional activities. Examples include design and testing of patient-directed Internet-based methods to improve chronic anti-coagulation, assessing outcomes of antenatal drug exposures, and testing of pharmacy interventions to prevent unsafe drug exposures.
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