Implementing A Regional Data Exchange Tool To Improve Medication Use And Safety

实施区域数据交换工具以改善药物使用和安全

• 批准号: 8374092
• 负责人: Kenneth S. Boockvar
• 金额: --
• 依托单位: JAMES J PETERS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8374092
• 关键词: Address; Admission activity; Adoption; Affect; Attention; Caring; Clinical Data; Cognitive; Consent; Continuity of Patient Care; Cost Savings; Data; Data Set; Decision Making; Diagnosis; Effectiveness; Electronic Health Record; Electronics; Engineering; Enrollment; Event; Funding; Future; Goals; Health; Health Personnel; Hospitals; Inpatients; Interview; Joints; Lead; Length of Stay; Maps; Measures; Medical Records; Methods; New York; Notification; Outcome; Patients; Pharmaceutical Preparations; Pharmacists; Pharmacy facility; Physicians; Procedures; Process; Provider; Randomized; Recording of previous events; Reporting; Research; Risk; Safety; Secure; Services; System; Testing; Time; Veterans; Work; base; computerized; control trial; cost; data exchange; experience; improved; information organization; interest; operation; patient safety; prevent; task analysis; tool; usability

Project Background: Medication reconciliation, a process by which a provider obtains and documents a thorough medication history with specific attention to comparing current and previous medication use, can prevent medication-related errors and harm. The most important information-related barrier to effective medication reconciliation is the unreliability of patients' own reports about their medication use and incomplete provider history-taking. The James J. Peters VA (JJP VA) is an original participating facility in the Bronx RHIO, a New York State-funded health information exchange organization that in October 2008 implemented secure clinical data information exchange among the largest healthcare providers in the Bronx. JJP VA providers can now access key clinical data, including medication use, from non-VA facilities with patients' consent. This presents a research opportunity to develop a medication review process that takes advantage of real-time non-VA medication use data to reduce adverse drug events in veterans. It also provides an opportunity to examine implementation factors regarding incorporating RHIO access into everyday workflow for VA providers. We posit that routine access to medication information from outside the VA has the potential to prevent harmful drug discrepancies and combinations, to prevent adverse drug events (ADEs), and reduce inpatient costs in veterans. Project Objectives: 1) To adapt a medication reconciliation process to include information from a regional health information exchange (RHIO), 2) To conduct a controlled trial of a medication reconciliation process at the time of hospital admission either enhanced or not enhanced with data from a regional health information exchange, and examine effects on transition drug risk, adverse drug events, and total inpatient costs, and 3) To identify system and provider factors that impede and facilitate adoption of the information exchange tool for routine use by VA providers. Project Methods: We will conduct qualitative and quantitative studies. First we will perform cognitive task analysis (CTA) to examine providers' decision-making and to map RHIO tool functions while providers interface with the tool, with interview questions to identify factors that facilitate or hinder use. Second we will enroll patients admitted to 2 inpatient units at the JJP VA, and assign them to receive usual medication reconciliation or RHIO-enhanced medication reconciliation with a notification to physicians about the patient's non-VA services that can be viewed in the RHIO. We will measure transition drug risk and ADEs by medical record review and patient interview, and measure inpatient costs with administrative cost data from national VA datasets. Third, we will conduct CTA with pharmacists and physicians at the end of the quantitative study who are expert in use of the tool to characterize differences in cognitive processes from prior to the quantitative study. This will supply information on system and provider factors that impede and facilitate adoption of the tool for routine use, and on potential improvements in the tool.

项目背景：药物核对是一个过程，通过这个过程，提供者获得和记录一个全面的用药史，特别注意比较当前和以前的药物使用，可以防止与药物有关的错误和伤害。有效药物协调的最重要的信息相关障碍是患者自己关于其药物使用的报告的不可靠性和不完整的提供者历史记录。James J. Peters VA（JJP VA）是布朗克斯RHIO的原始参与机构，RHIO是纽约州资助的健康信息交换组织，于2008年10月在布朗克斯最大的医疗保健提供商之间实施了安全的临床数据信息交换。JJP VA提供者现在可以从非VA设施访问关键临床数据，包括药物使用， 患者的同意。这提供了一个研究机会，开发一个药物审查过程，利用实时非VA药物使用数据，以减少退伍军人的药物不良事件。它还提供了一个机会，以检查有关将RHIO访问纳入VA提供者的日常工作流程的实施因素。我们认为，从VA外部常规获取药物信息有可能防止有害的药物差异和组合，防止药物不良事件（ADE），并降低退伍军人的住院费用。 项目目的：1）调整药物核对过程，以包括来自区域健康信息交换（RHIO）的信息，2）在入院时进行药物核对过程的对照试验，无论是否使用来自区域健康信息交换的数据进行增强，并检查对过渡药物风险、药物不良事件和总住院费用的影响，以及3）识别阻碍和促进VA提供者日常使用信息交换工具的系统和提供者因素。 项目方法：我们将进行定性和定量研究。首先，我们将进行认知任务分析（CTA），以检查供应商的决策，并映射RHIO工具的功能，而供应商接口的工具，与访谈问题，以确定促进或阻碍使用的因素。其次，我们将入组JJP VA 2个住院单位的患者，并将其分配接受常规药物核对或RHIO增强药物核对，并通知医生可在RHIO中查看患者的非VA服务。我们将通过病历审查和患者访谈来衡量过渡药物风险和ADE，并使用来自国家VA数据集的管理成本数据来衡量住院费用。第三，我们将在定量研究结束时与药剂师和医生进行CTA，他们是使用该工具的专家，以表征定量研究前认知过程的差异。这将提供有关系统和供应商因素的信息，这些因素阻碍和促进了该工具在日常使用中的采用， 工具的改进。