Minimizing Errors in Medication Histories Obtained at Hospital Admission

描述(由申请人提供)：Joshua Pevnick，医学博士，MSHS是一名普通内科医生，在Cedars-Sinai Health System(CSHS)和UCLA担任助理教授。他从事医院医学工作，并一直在进行卫生服务研究(HSR)，重点是信息技术干预，以改善药物管理。最近，他发现最可能从他的工作中受益的是老年人，因为他们的药物治疗方案最复杂，记住这些方案的能力最差，耐受不良药物事件的生理储备也最少。此外，他几乎所有的临床工作和研究都是在CSHS进行的，众所周知，CSHS的老年人口不成比例。最后，这个问题最好是以患者为中心，而不是以解决方案为中心的方式。由于所有这些原因，进一步的老年训练将大大有利于他的研究。因此，他最近改变了自己的职业目标：成为一名领先的卫生服务研究人员，推动护理过渡期老年人药物管理的研究。为了实现这一目标，佩夫尼克博士提出了一项包括四位导师的定期会议的指导计划：Douglas Bell医学博士、博士(信息学内容专业知识、高铁研究方法学专业知识)、Catherine Sarkisian医学博士、MSPH(老年病学内容专业知识、高铁研究方法学专业知识)、Cynthia Jackevicius、PharmD(药学内容专业知识、高铁研究方法学专业知识)和Andre Rogatko博士(生物统计学和试验设计方法学专业知识)。他的职业发展还将得到培训计划的支持，培训计划侧重于老年病学、临床试验设计、格兰特写作和医学信息学。最后，他将进行一个研究项目，以产生对自身而言重要的成果，作为应用他从导师和课程中学到的东西的工具，并为未来的研究建议奠定基础。佩夫尼克博士建议研究三种干预措施，以提高入院时获得的用药记录的准确性。这些干预措施将针对容易出现错误用药史和随之而来的用药错误的老年患者。对于主要接受复杂家庭药物治疗的老年患者，佩夫尼克博士正在进行一项随机对照试验(RCT)，以测试使用药剂师和药房技术人员获取初始入院用药历史(AMH)对其准确性的影响。他将回顾研究在入院时访问电子药物填写数据以提高AMH准确性的潜在好处。在分析了这些干预措施如何影响AMH的准确性以及这些干预措施的劳动力成本之后，佩夫尼克博士将领导设计和改进针对老年人的联合干预措施，最终将在第二次随机对照试验中进行测试。提高AMH的准确性被认为是预防不良药物事件的必要的第一步，每年美国住院患者中有超过10万人死于不良药物事件。除了研究应对这一公共健康威胁的潜在解决方案外，这项研究项目还将为佩夫尼克博士提供机会，让他成为老龄科学领域领先的独立研究员。

DESCRIPTION (provided by applicant): Joshua Pevnick, MD, MSHS is a general internist with Assistant Professor appointments at Cedars-Sinai Health System (CSHS) and UCLA. He practices hospital medicine and has been conducting health services research (HSR) focusing on information technology interventions to improve medication management. Recently, he has seen that those likely to benefit most from his work are older adults, as they have the most complex medication regimens, the least ability to remember these regimens, and the least physiologic reserve to tolerate adverse drug events. Furthermore, almost all of his clinical work and research is conducted at CSHS, which is known to have a disproportionately older population. Finally, this issue is best addressed in a patient-centric, rather than solution-centri, manner. For all of these reasons, further geriatric training would substantially benefit his research. He has thus recently changed his career goal to: Become a leading health services researcher advancing the study of medication management in seniors at care transitions. To achieve this goal, Dr. Pevnick proposes a mentoring plan involving regular meetings with four mentors: Douglas Bell, MD, PhD (content expertise in informatics, methodological expertise in HSR), Catherine Sarkisian, MD, MSPH (content expertise in geriatrics, methodological expertise in HSR), Cynthia Jackevicius, PharmD (content expertise in pharmaceutical sciences, methodological expertise in HSR), and Andre Rogatko, PhD (methodological expertise in biostatistics and trial design). His career development will also be supported by training plans emphasizing geriatrics, clinical trial design, grantwriting and medical informatics. Finally, he wil conduct a research project to generate results important for their own sake, to serve as a vehicle to apply what he learns from mentors and classes, and to build a foundation for future research proposals. Dr. Pevnick proposes to study three interventions to improve the accuracy of medication histories obtained at hospital admission. The interventions will target older adult patients prone to erroneous medication histories and concomitant medication errors. For predominantly older patients on complex home medication regimens, Dr. Pevnick is conducting a randomized controlled trial (RCT) to test the effect of using pharmacists and pharmacy technicians to obtain an initial admission medication history (AMH) on its accuracy. He will retrospectively study the potential benefit of accessing electronic medication fill data at the tim of admission to improve AMH accuracy. After analyzing both how these interventions affect AMH accuracy and the labor costs for these interventions, Dr. Pevnick will lead the design and refinement of a combined intervention targeted at seniors, which will ultimately be tested in a second RCT. Improving AMH accuracy is accepted as a necessary first step in preventing adverse drug events, which cause over 100,000 deaths in hospitalized US patients annually. Beyond studying potential solutions to this public health threat, this research project will provid Dr. Pevnick the opportunity to develop himself into a leading independent investigator in aging science.