Integrating Pharmacists into an Automated Discharge Process to Promote Comprehensive Medication Management

项目摘要 从医院到初级保健环境的过渡(TOC)是一个脆弱时期 发生可导致再次住院的不良药物事件(ADE)。ADES是最多的 常见的不良事件发生在出院后，通常是可以预防的。考虑到他们的培训和专业知识 在药物治疗方面，药剂师可以发挥关键作用，提高向 患者在TOC期间。当以一致、高保真的方式实施时，药剂师提供 在TOC流程之外提供的综合药物管理(CMM)已被证明能够 改善再住院率、临床结果和卫生系统支出。目前尚不清楚的是 如何在初级保健环境中高效地将CMM服务集成到TOC工作流中 最近出院的病人。此外，这些进程在 具有较高社会健康决定因素(SDOH)的人群，这些人群存在重大障碍，可能会预防 及时的随访护理在文献中被系统地研究得不够。本研究使用经过调整的综合 实施研究框架(CFIR)和RE-AIM模型，以评估 药剂师主导的CMM在TOC中。为了促进医院和初级保健机构之间的沟通，这 工作流程将利用自动电子警报系统(EAS)通知站点在以下情况下需要CMM 去医院就诊。尽管已有研究研究了实施急救系统对改善医疗保健的影响 在与初级保健提供者的协调下，很少有研究利用EAS来提供CMM。研究团队 将与明尼苏达州联邦合格健康中心城市健康中心合作进行这项研究 网络(FUHN)，作为国家第一个安全网责任关怀组织运作。目标1将 确定在以患者为中心的TOC中实施和采用CMM的促进者和障碍 工作流程。这一目标使用形成性评估方法来获得药剂师、提供者、 诊所领导层和护理协调员发现实施CMM的障碍和促进者 目录工作流。目标2将评估将CMM实施为以患者为中心的实施结果 目录工作流。这一目标使用了一项观察性研究设计，其中包括医疗补助声明和电子健康记录 (EHR)信息，以检查在TOC中实现、采用、实施和维护CMM的情况 采用RE-AIM模型。目标3将重点放在RE-AIM框架的功效部分，方法是 评估将CMM纳入以患者为中心的TOC工作流程的安全性和有效性 通过使用医疗补助索赔数据和电子病历评估CMM交付对再次住院率的影响 信息。归根结底，这项研究的目标是产生关键的学习，以促进采用和 持续的CMM，以提高患者在TOC期间的安全性。这一进程的实施预计将 通过减少入院人数和改善临床结果，对患者安全产生积极影响。

Project Summary Transitions of care (TOC) from the hospital to primary care setting presents a vulnerable period for the occurrence of adverse drug events (ADEs) which can result in hospital readmission. ADEs are the most common adverse event occurring post-discharge and are often preventable. Given their training and expertise in medications, pharmacists can play a crucial role in improving the safety and quality of care delivered to patients during TOC. When implemented in a consistent, high-fidelity manner, pharmacist-provided comprehensive medication management (CMM) provided outside of the TOC process has been shown to improve hospital readmission rates, clinical outcomes, and health system spending. What remains unknown is how to effectively and efficiently integrate CMM services into TOC workflows in a primary care setting for patients recently discharged from the hospital. Furthermore, the implementation of these processes in a population with high social determinants of health (SDOH) which have significant barriers that may prevent timely follow-up care is systematically understudied in the literature. This study uses an adapted Consolidated Framework for Implementation Research (CFIR) and the RE-AIM model to evaluate the implementation of pharmacist-led CMM in a TOC. To facilitate communication between the hospital and primary care setting, this workflow will utilize an automated electronic alert system (EAS) to notify sites of the need for CMM following a hospital visit. Although studies have examined the effect of implementing an EAS on improvements in care coordination with primary care providers, few studies have utilized EAS to delivery CMM. The research team will conduct this study in collaboration with the Minnesota Federally Qualified Health Center Urban Health Network (FUHN) which operates as the nation’s first safety-net Accountable Care Organization. Aim 1 will identify facilitators and barriers to the implementation and adoption of CMM in a patient-centered TOC workflow. This aim uses a formative evaluation approach to obtain the perspectives of pharmacists, providers, clinic leadership, and care coordinators to uncover barriers and facilitators to the implementation of CMM into TOC workflow. Aim 2 will evaluate the implementation outcomes of implementing CMM into a patient-centered TOC workflow. This aim uses an observational study design with Medicaid claims and electronic health record (EHR) information to examine the reach, adoption, implementation, and maintenance of CMM in TOC employing the RE-AIM model. Aim 3 will focus on the efficacy component of the RE-AIM framework by evaluating the safety and effectiveness outcomes of incorporating CMM into a patient-centered TOC workflow by evaluating the impact of CMM delivery on hospital readmission rates using Medicaid claims data and EHR information. Ultimately, the goal of this research is to generate key learnings that will facilitate the adoption and sustainability of CMM to improve patient safety during TOC. The implementation of this process is expected to result in positive impact on patient safety by decreasing hospital admissions and improving clinical outcomes.