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Their clinical outcomes assessment is based on the rate of exceptions, and not the rate of alerts, sent to the physician.
A previous study by Hennessy et al 8 on RDUR prescribing errors and clinical outcomes was unable to identify an effect of RDUR on the rate of exceptions or clinical outcomes.
The exception column gives the rate of exceptions for each generic recommendations (number of exceptions/denominator; the denominator is either 43, the total number of drug classes, or 113, the total number of recommended treatments found in the five guidelines).
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For each practice and each clinical indicator we calculated the rate of exception reporting as the number of excepted patients divided by the number of eligible patients: ERi=Ei/(Ei+Di) Where Ei is the number of patients exception reported for that indicator and Di is the number of patients meeting the criteria for the indicator and not excepted by the practice.
Higher achieving practices were generally similar to all practices but they showed a slightly higher rate of exception reporting than all practices.
The median rate of exception reporting after the first year was small <6% and we did not make any adjustment for this[ 8].
Results The median rate of exception reporting was 2.7% (interquartile range 1.9-3.9 1.9-3.9ll and 0.44% (0.14-1.1%) foverallrmed dissent, but vandation in rates was wide between practices and across indicators.
On the other hand, some specific indicators have much higher rates of exception reporting [ 28].
As with previous studies, 16 26 we found that overall rates of exception reporting were generally low but varied widely by indicator.
Main outcome measures Rates of exception reporting for 37 clinical quality indicators, associations of patient and general practice factors with exception rates, and financial gain for practices relating to their use of exception reporting.
The authors conclude that "Exception reporting brings substantial benefits to pay-for-performance programs, providing that the process has been used appropriately" and that "Rates of exception reporting have generally been low, with little evidence of widespread gaming".[ 10].
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