药物协调工具安全消息传递 (SMMRT) 试用-猫眼课题宝

药物协调工具安全消息传递 (SMMRT) 试用

批准号：

9145515

负责人：

STEVEN R. SIMON

金额：

$0.0万

依托单位：

VA BOSTON HEALTH CARE SYSTEM

依托单位国家：

美国

项目类别：

财政年份：

2015

资助国家：

美国

项目状态：

已结题

起止时间：

2015-07-01 至 2019-09-30

来源：

https://reporter.nih.gov/project-details/9145515

关键词：

Address Address Admission activity Adverse drug event Adverse drug event Adverse event Adverse event Area Area Caring Caring Cessation of life Cessation of life Client satisfaction Client satisfaction Clinical Collaborations Collaborations Communication Communication Communities Communities Effectiveness Effectiveness Electronic Mail Electronic Mail Elements Elements Emergency department visit Emergency department visit Enrollment Enrollment Ensure Ensure Future Future Goals Goals Health Health Healthcare Healthcare Home environment Home environment Hospitalization Hospitalization Hospitals Hospitals Informatics Informatics Information Technology Information Technology Inpatients Inpatients Internet Internet Intervention Intervention Interview Interview Joints Joints Lead Lead Length of Stay Measures Measures Mediating Mediating Medical Records Medical Records Modeling Modeling Nurses Nurses Outcome Measure Outcome Measure Outpatients Outpatients Patient Discharge Patients Patients Pharmaceutical Preparations Pharmaceutical Preparations Pharmacists Pharmacists Pilot Projects Pilot Projects Primary Health Care Primary Health Care Primary Nursing Care Primary Nursing Care Qualitative Methods Qualitative Methods Randomized Randomized Randomized Controlled Trials Randomized Controlled Trials Reporting Reporting Research Research Research Personnel Research Personnel Secure Secure Self Efficacy Self Efficacy Testing Testing Training Training Veterans Veterans Visit Visit arm arm base base clinical practice clinical practice experience experience formative assessment formative assessment graphical user interface graphical user interface health administration health administration high risk high risk hospital readmission hospital readmission hospital utilization hospital utilization improved improved improved outcome improved outcome medication administration novel novel patient engagement patient portal pharmacy benefit pharmacy benefit prevent prevent primary outcome primary outcome programs programs satisfaction secondary outcome secondary outcome tool tool treatment as usual treatment as usual usability usability

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DESCRIPTION (provided by applicant): Medication discrepancies, defined as unintentional differences found between patients' medical records and patients' reports of the medication they are taking, occur frequently after hospital discharge, predisposing to adverse drug events (ADEs), emergency department visits and readmissions. Resolving medication discrepancies - medication reconciliation - is mandated at every care transition, but little is known about intervention strategies to improve medication reconciliation in the post-discharge period, when patients may lack prompt access to primary care and are at high risk for ADEs. To address this gap, we developed and pilot tested the Secure Messaging for Medication Reconciliation Tool (SMMRT), with a pharmacist communicating with Veterans to review medications and reconcile discrepancies after hospital discharge via Secure Messaging (SM), within My HealtheVet (MHV), VA's patient portal. Our pilot study detected, on average, two clinically important medication discrepancies per Veteran immediately following discharge and demonstrated that Veterans could interact with the pharmacist asynchronously to resolve discrepancies. Veterans found SMMRT easy to use and indicated they would willingly use it again. We therefore propose the SMMRT Trial, in which we will optimize the end-users' experience with SMMRT, conduct a randomized controlled trial (RCT) of MHV training and SMMRT to reduce hospital utilization, and evaluate SMMRT for potential future implementation. For Aim 1, we will conduct formal usability assessment of SMMRT among Veterans (N=10) pharmacists (N=10) and nurses (N=10), refining the user interface for optimal acceptability and effectiveness. For Aim 2, we will mount a 3-arm RCT to evaluate the effects of MHV training and SMMRT, randomizing 1,400 hospitalized Veterans to compare 1) Usual Care (UC), 2) UC + MHV enrollment and training (i.e., "MHV training"), and 3) UC + MHV training + SMMRT after discharge. The primary outcome measure will be 30-day hospital utilization (combined readmissions plus emergency department visits) with the primary hypothesis that SMMRT will reduce hospital utilization compared with UC. For Aim 3, we will carry out a formative evaluation of the interventions for potential future implementation, with qualitative analysis of in-depth interviews from among 20 Veterans and 10-15 primary care nurses. We will collaborate with operational partners: the Veterans' Consumer Health Information Office, which oversees MHV program activities, and the National Medication Reconciliation Initiative, within Pharmacy Benefits Management, responsible for implementing the VA Directive regarding medication reconciliation. If proven effective, SMMRT will have several impacts on Veterans and their health care: 1) decreased medication discrepancies; 2) decreased emergency room visits and hospital readmissions following discharge, which are commonly the result of ADE; 3) improved measures of patient- engagement, patient-centeredness, and patient satisfaction. This study directly supports VA's Transformational Initiative to employ state-of-the-art information technology in the delivery of Veterans' health care.

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