Multi-Center Medication Reconciliation Quality Improvement Study - MARQUIS

多中心药物协调质量改进研究 - MARQUIS

• 批准号: 8149965
• 负责人: Jeffrey Lawrence Schnipper
• 金额: $ 49.85万
• 依托单位: SOCIETY OF HOSPITAL MEDICINE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2013-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8149965
• 关键词: Multi; Center; Medication; Reconciliation; Quality

DESCRIPTION (provided by applicant): Unintentional medication discrepancies during transitions in care (such as hospitalization and subsequent discharge) are very common and represent a major threat to patient safety. One solution to this problem is medication reconciliation. In response to Joint Commission requirements, most hospitals have developed medication reconciliation processes, but some have been more successful than others, and there are reports of pro-forma compliance without substantial improvements in patient safety. There is now collective experience about effective approaches to medication reconciliation, but these have yet to be consolidated, evaluated rigorously, and disseminated effectively. The broad, long-term objective of this research is to optimize, widely implement, and evaluate medication reconciliation interventions that improve patient safety during transitions in care. The specific aims are to: 1) develop a toolkit consolidating current best practice recommendations for medication reconciliation; 2) conduct a multi-center mentored quality improvement project in which each site adapts the tools for its own environment and implements them to make measurable progress in several facets of the medication reconciliation process; 3) assess the effects of this intervention on unintentional medication discrepancies; and 4) conduct rigorous program evaluation to determine the most important components of the intervention and how best to implement it. Based on expert recommendations from a recent conference on medication reconciliation sponsored by the Society of Hospital Medicine and funded by AHRQ, investigators will engage a steering committee and conduct a second conference to operationalize these recommendations into a set of "best practice" guidelines, standards, and tools to be adapted by each of 6 participating sites. After training mentors and developing data collection tools, a mentored quality improvement project will be conducted for 21 months, in which each site works to improve medication reconciliation using the toolkit and with mentorship in the form of two site visits and monthly phone calls. Sites will be given assistance with data collection, including data collection tools, on- site training in their use, and a second visit to ensure reliable data collection. Unintentional medication discrepancies at admission and discharge will be analyzed monthly using interrupted time-series methods to track the effects of the individual facets of the intervention over time, adjusted for temporal trends and site- specific effects. Program evaluation will be conducted using mixed qualitative and quantitative methods in order to understand factors that contribute to successfully achieving medication reconciliation goals. This project's findings will provide valuable lessons to all hospitals regarding the best ways to design and implement medication reconciliation interventions to improve medication safety during transitions in care. PUBLIC HEALTH RELEVANCE: Patients often have problems after they leave the hospital, in part because errors are made in the medications they are prescribed. The goal of this project is to develop a more accurate and safe medication prescription process when patients enter and leave the hospital and implement this process at six US hospitals. We will measure the success of the project and develop lessons learned so this process can be applied to other hospitals.

描述（由申请人提供）：在护理过渡期间（如住院和随后出院），意外用药差异非常常见，对患者安全构成重大威胁。解决这个问题的一个办法是药物和解。根据联合委员会的要求，大多数医院都制定了药物核对程序，但有些医院比另一些医院更成功，有报告称，形式上的遵守情况没有在病人安全方面得到实质性改善。现在有关于药物协调的有效方法的集体经验，但这些经验尚未得到巩固，严格评估和有效传播。这项研究的广泛，长期目标是优化，广泛实施和评估药物协调干预措施，以提高患者在护理过渡期间的安全性。具体目标是：1）开发一个工具包，整合当前药物协调的最佳实践建议; 2）开展一个多中心指导的质量改进项目，其中每个研究中心根据自身环境调整工具并实施它们，以在药物协调过程的几个方面取得可衡量的进展; 3）评估这种干预对无意药物差异的影响;进行严格的项目评估，以确定干预措施的最重要组成部分以及如何最好地实施。根据最近由医院医学协会主办、AHRQ资助的药物协调会议的专家建议，调查人员将与一个指导委员会接触，并举行第二次会议，将这些建议落实为一套“最佳做法”准则、标准，以及6个参与研究中心各自采用的工具。在培训导师和开发数据收集工具后，将开展为期21个月的质量改进指导项目，其中每个研究中心都将利用工具包并通过两次现场访问和每月电话辅导的形式，努力改进药物核对。研究中心将获得数据收集方面的协助，包括数据收集工具、使用工具的现场培训以及第二次访视，以确保数据收集的可靠性。将使用中断时间序列方法每月分析入院和出院时的非故意用药差异，以跟踪干预各个方面随时间的影响，并根据时间趋势和研究中心特异性影响进行调整。将使用定性和定量混合方法进行项目评价，以了解有助于成功实现药物协调目标的因素。该项目的研究结果将为所有医院提供有关设计和实施药物协调干预措施的最佳方法的宝贵经验，以提高护理过渡期间的药物安全性。 公共卫生相关性：病人在离开医院后经常会出现问题，部分原因是他们开的药有错误。该项目的目标是开发一个更准确和安全的药物处方过程，当病人进入和离开医院，并在六家美国医院实施这一过程。我们将衡量该项目的成功并总结经验教训，以便该流程可以应用于其他医院。