Relationship between medication event rates and the Leapfrog computerized physician order entry evaluation tool

J Am Med Inform Assoc. 2013 Jun;20(e1):e85-90. doi: 10.1136/amiajnl-2012-001549. Epub 2013 Apr 18.


Objective: The Leapfrog CPOE evaluation tool has been promoted as a means of monitoring computerized physician order entry (CPOE). We sought to determine the relationship between Leapfrog scores and the rates of preventable adverse drug events (ADE) and potential ADE.

Materials and methods: A cross-sectional study of 1000 adult admissions in five community hospitals from October 1, 2008 to September 30, 2010 was performed. Observed rates of preventable ADE and potential ADE were compared with scores reported by the Leapfrog CPOE evaluation tool. The primary outcome was the rate of preventable ADE and the secondary outcome was the composite rate of preventable ADE and potential ADE.

Results: Leapfrog performance scores were highly related to the primary outcome. A 43% relative reduction in the rate of preventable ADE was predicted for every 5% increase in Leapfrog scores (rate ratio 0.57; 95% CI 0.37 to 0.88). In absolute terms, four fewer preventable ADE per 100 admissions were predicted for every 5% increase in overall Leapfrog scores (rate difference -4.2; 95% CI -7.4 to -1.1). A statistically significant relationship between Leapfrog scores and the secondary outcome, however, was not detected.

Discussion: Our findings support the use of the Leapfrog tool as a means of evaluating and monitoring CPOE performance after implementation, as addressed by current certification standards.

Conclusions: Scores from the Leapfrog CPOE evaluation tool closely relate to actual rates of preventable ADE. Leapfrog testing may alert providers to potential vulnerabilities and highlight areas for further improvement.

Keywords: Leapfrog; clinical decision support; computerized physician order entry; medication safety.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Drug-Related Side Effects and Adverse Reactions*
  • Hospitals, Community
  • Humans
  • Massachusetts
  • Medical Order Entry Systems*
  • Medication Errors / prevention & control
  • Medication Errors / statistics & numerical data*