Optimizing Medication Reconciliation for Older Veterans in Home Health Care

描述(由申请人提供)： 药物差异，或患者认为他们应该服用的药物与他们的医疗保健提供者共同订购的方案之间的差异，会影响多达70%的患者出院后。由于多种并存和复杂的药物治疗方案，老年退伍军人面临的风险尤其大。在解决药物差异方面经常存在延误，这是不良药物事件(ADE)的主要原因。在老年退伍军人中，33%的人在出院后的头几个月经历了ADE，大大增加了他们再次住院的风险。药物调节，即确定患者应该服用最准确的药物清单的过程，是减少潜在有害药物差异从而提高药物安全性的重要策略。出院后，家庭健康护士可以很好地进行药物调节；事实上，他们被要求记录差异并提醒治疗医生。虽然每年都有更多的老年退伍军人利用家庭卫生服务，但人们对解决家庭卫生保健环境中的药物差异的过程和有效性知之甚少。目前，家庭健康护士没有一种标准化的方法来识别、区分轻重缓急，并与治疗医生(S)沟通差异。此外，解决差异的时间延长会增加老年退伍军人因药物治疗而受到的潜在伤害。因此，需要工具来改善药物调节。我的长期职业目标是成为一名独立的调查员，他的发现改善了老年退伍军人护理过渡的过程和结果。这一职业发展奖将使我在医院出院过渡和药物调节方面获得更多专业知识，改进测量差异的方法，并设计和测试试点干预措施，以增强家庭药物调节。本研究的具体目的是：1)采用定性和定量相结合的方法，观察和记录家庭健康药物调节过程中的变化。我将观察为最近出院的老年退伍军人完成药物对账的步骤，以便记录当前做法的变化。2)根据相关医疗保健提供者的意见，制定用于识别、优先排序、沟通和解决POST的药物对账方案 及时出院用药差异。焦点小组将为制定一项协议提供信息，以帮助家庭健康护士确定哪些药物差异在临床上最重要，并塑造沟通工具，以标准化药物差异向医生传达的方式。3)评估协调协议和沟通工具在缩短解决出院后用药差异的时间方面的可行性、可接受性和有效性。这一试点将为一项更大规模、资金更雄厚的干预有效性研究奠定基础。培训计划和有指导的研究活动将实现以下目标：a)通过教学培训和体验式学习提高我的方法技能(定性和定量)；b)通过一系列教育经验以及参加期刊俱乐部和研究会议，获得实施科学和老年病学方面的更多专业知识；c)在跨学科团队的指导下，开发、实施和评估工具，以提高出院后的用药安全性。所有颁奖活动都将在退伍军人事务部老年医学研究和教育临床中心(GRECC)充满活力和支持性的科学环境中进行。总之，通过完成这项职业发展奖，我将获得必要的技能和经验，适用于进行未来的转化性研究，以改善老年退伍军人的用药安全，从而可能减少再次住院。

DESCRIPTION (provided by applicant): Medication discrepancies, or differences between what medications patients think they should be taking and the regimen collectively ordered by their healthcare providers, affect up to 70% of patients following hospital discharge. Older Veterans are particularly at risk, owing to multiple comorbidities and complex medication regimens. Frequently there are delays in resolving medication discrepancies, which are major contributors to adverse drug events (ADEs). Among older Veterans 33% experience an ADE in the first few months after hospital discharge, substantially increasing their risk of hospital readmission. Medication reconciliation, the proces of identifying the most accurate list of medications a patient should be taking, is an important strategy to reduce potentially harmful medication discrepancies, thereby improving medication safety. After hospital discharge, home health nurses are well-positioned to perform medication reconciliation; indeed, they are required to document discrepancies and alert the treating physicians. Though more older Veterans are utilizing home health services each year, little is known about the process and effectiveness of resolving medication discrepancies in the home healthcare setting. Currently, there is no standardized approach for home health nurses to identify, prioritize, and communicate discrepancies to the treating physician(s). Furthermore, prolonged time to resolution of discrepancies places older Veterans at increased potential harm due to medications. Therefore, tools to improve medication reconciliation are needed. My long-term career goal is to be an independent investigator whose discoveries improve the processes and outcomes of care transitions for older Veterans. This career development award will allow me to gain greater expertise in hospital discharge transitions and medication reconciliation, advance the methodology in measuring discrepancies, and design and test a pilot intervention to enhance home-based medication reconciliation. The specific aims of the research are to: 1) Observe and document variation in the process of home health medication reconciliation using both qualitative and quantitative methods. I will observe the steps to complete medication reconciliation for older Veterans recently discharged from the hospital in order to document the variation in current practice. 2) With input from relevant health care providers, develop a medication reconciliation protocol for identifying, prioritizing, communicating, and resolving post discharge medication discrepancies in a timely manner. Focus groups will inform development of a protocol to help home health nurses prioritize which medication discrepancies are most clinically important and shape the communication tool to standardize how medication discrepancies are communicated to physicians. 3) Evaluate the feasibility, acceptability, and effectiveness of the reconciliation protocol and communication tool on reducing the time to resolution of post-discharge medication discrepancies. This pilot will set the stage for a larger, more robustly funded study of the intervention's effectiveness. The training program and mentored research activities will achieve the following objectives: a) advance my methodological skills (both qualitative and quantitative) through didactic training and experientia learning; b) gain additional expertise in implementation science and geriatrics through a series of educational experiences, as well as participating in journal clubs and research meetings; and c) develop, implement, and evaluate tools to improve medication safety after hospital discharge with guidance from an interdisciplinary team. All of the award activities will take place in a vibrant and supportive scientific environment grounded in the VA Geriatrics Research and Education Clinical Center (GRECC). In summary, by completing this career development award I will acquire indispensable skills and experience applicable to conducting future translational studies that improve medication safety for older Veterans, thereby possibly reducing hospital readmissions.