Improving Medication Management Practices and Care Transitions through Technology

描述(由申请人提供)：家庭健康组织为以多种慢性病为特征的以医疗保险为主的人口提供急性后护理。在家庭健康患者中发现的药物数量和用药方案的复杂性给护士和患者带来了重大的管理问题。这项研究将进行一项随机试验，以检验两种信息技术(“基本”和“增强”)干预措施的有效性和成本效益，这两种干预措施旨在通过改善临床医生实践和增强患者参与度来促进高质量的护理过渡，使因服用的药物和/或药物方案的复杂性而面临潜在严重用药问题的家庭健康患者面临潜在的严重用药问题。临床信息系统、临床医生提醒和护士的护理决策支持将由患者定制的电子、CD和硬拷贝格式的信息补充，直接发送到患者家中。“基本”干预将使用一种算法，在服务点提醒家庭健康护士注意存在潜在严重药物问题风险的患者，并为临床医生提供决策支持，包括集成到临床医生访问记录系统和电子患者健康记录中的高风险药物管理建议。“增强”干预将包括针对家庭健康护士的基本干预的所有IT元素，以及为在家的患者设计并直接提供的信息。分析将评估基本和强化干预措施对护理做法和护理过程(例如决策支持工具的利用、文件的及时性/完整性、与药物有关的沟通)、对患者结果(例如健康状况、药物复杂性、服务使用)和费用的影响。这些因变量的测量将从主要数据和次要数据的组合中得出。回归模型将被用来控制三组护士在可能影响护理实践或护理过程的特征方面的差异(通常、基本、增强)。回归模型也将被用来控制不同患者组之间的差异，这些差异可能会影响护士的用药管理或患者的健康和药物相关的结果。最后，将估计与每个干预措施和随后的护理相关的费用，并将其与各种干预措施以及与常规护理相关的费用进行比较。将描述在相应干预措施下提供的护理的成本和有效性之间的关系，以及这些关系对家庭护理政策和方案倡议的影响。

DESCRIPTION (provided by the applicant): Home health organizations provide post-acute care to a predominantly Medicare population characterized by multiple chronic conditions. The number of drugs and complexity of medication regimens found among home health patients pose significant management problems for both nurses and patients. This study will conduct a randomized trial to examine the effectiveness and cost-effectiveness of two information technology (IT) interventions ("basic" and "augmented") aimed at facilitating high quality care transitions through improved clinician practice and enhanced patient engagement among home health patients at risk of a potentially serious medication problem due to the drugs they are taking and/or the complexity of their medication regimens. Clinical information systems, clinician reminders and point-of-care decision support for nurses will be complemented by patient-tailored information in electronic, CD and hard copy formats delivered directly to the patient's home. The "basic" intervention will use an algorithm to alert the home health nurse, at the point of service, to a patient at risk of a potentially serious medication problem and provides the clinician with decision support, including high-risk medication management recommendations that are integrated into the clinician's visit documentation system and the electronic patient health record. The "augmented" intervention will include all the IT elements of the basic intervention targeted to the home health nurse plus information designed for and directly delivered to patients at home. The analysis will estimate the impact of the basic and augmented interventions on nursing practices and processes of care (e.g., utilization of decision support tools, timeliness/ completeness of documentation, medication-related communications), on patient outcomes (e.g., health status, medication complexity, service use), and on costs. Measures of these dependent variables will be derived from a combination of primary and secondary data. Regression models will be used to control for differences among nurses in the three groups (usual, basic, augmented) with respect to characteristics that might influence practices or processes of care. Regression models also will be used to control for differences across patient groups that might influence nurses' medication management or patients' health and medication-related outcomes. Finally, the costs associated with each of the interventions and subsequent care will be estimated and compared across interventions and relative to usual care. The relationships between costs and effectiveness of care delivered under the respective interventions will be described, as will the implications of these relationships for home care policy and program initiatives.