Patient-Driven Medication Safety Learning Laboratory in Care Transitions

项目摘要/摘要 在世界各地的卫生保健系统中，药物伤害是伤害的主要原因，也是可避免的伤害。这 对于老年人来说尤其如此，他们受到药物伤害的风险更高，特别是在 护理(TOC)，因为他们经常服用多种药物，并在 住院治疗。老年患者和照顾者在实现安全方面存在主要差距和障碍 护理过渡期间和之后的用药情况。这一拟议的学习实验室将使患者和 护理员与医疗保健系统团队合作，从分析现有药物开始 安全工作体系，横跨整个护理过渡。这将导致设计、开发和 在模拟环境中使用实践输入测试可扩展的以人为中心的干预措施 临床医生和患者作为最终用户，然后在临床环境中进行中试。要完成 为此，研究小组将遵循五个阶段的系统工程方法论来实现以下目标 目标：目标1：问题分析-该目标使用多方面的方法来识别和理解 护理过渡期间药物问题的原因和后果，包括以下方面的需求和优先事项 患者和护理人员，以及影响和制约护理过渡工作的操作复杂性。这个 团队将：目标1(A)研究患者和照顾者最近住院的经历，重点是 健康相关挑战的用药变化、相关症状和社会决定因素；目标1(B) 执行认知工程分析，以确定认知工作挑战及其相关信息 医院和初级保健地点的护理过渡工作所涉及的需求；以及目标1(C)利用卫生 信息交换(HIE)数据，以识别患者和系统级别的风险因素并开发风险算法 因意外住院和药物伤害。目标2：(A)设计、开发、(B)实施、 和评估。该团队将：目标2(A)反复设计和开发以患者为导向的干预措施和投入 来自主要利益攸关方(例如，项目社区咨询委员会成员)；和目标2(B)执行 并评估有前景的解决方案-首先在模拟环境中(具有现实的任务)，然后在 临床环境。这项提议的总体目标是开发一个跨系统的学习实验室，使 以创新的方式将老年人、照顾者、研究人员和医疗保健团队结合在一起，保护他们免受 药物危害。我们的方法将重点放在患者和照顾者身上，并关注社会 健康的决定因素，并将它们广泛地应用于系统工程过程的每一步。这个 从该计划中学习实验室基础设施和试点数据将为持续 利益相关者伙伴关系，将产生未来资助的研究，以提高老年人的用药安全性。

Project Summary/Abstract Medication harm is a leading cause of injury and avoidable harm in health care systems across the world. This is especially true for older adults, who are at higher risk for medication harm, especially around transitions of care (TOC), as they often take multiple medicines and have several changes made to their medicines during inpatient admission. There are major gaps and barriers for older adult patients and caregivers to achieve safe medication use during and after care transitions. This proposed Learning Lab will empower patients and caregivers in partnership with the healthcare system team, starting with analyzing the existing medication safety work system, spanning the entire transition of care. This will lead to the design, development, and testing of scalable human-centered interventions in a simulated environment with input from practicing clinicians and patients as the end-users, followed by pilot testing in the clinical environment. To accomplish this, the research team will follow the five-phase, systems-engineering methodology to achieve the following aims: Aim 1: Problem Analysis – This aim uses a multifaceted approach to identify and understand the causes and consequences of medication problems in transitions of care, including the needs and priorities of patients and caregivers, and the operational complexities that shape and constrain care transition work. The team will: Aim 1(a) study patients’ and caregivers’ experiences with recent hospitalizations, focusing on medication changes, associated symptoms, and Social Determinants of Health-related challenges; Aim 1(b) perform cognitive engineering analysis to identify cognitive work challenges and their associated information needs involved in the care transition work at hospital and primary care sites; and Aim 1(c) use health information exchange (HIE) data to identify patient- and system-level risk factors and develop risk algorithms for unplanned hospitalizations and medication harm. Aim 2: (a) Design, Development, (b) Implementation, and Evaluation. The team will: Aim 2(a) iteratively design and develop patient-driven interventions with inputs from key stakeholders (e.g., members of the project’s Community Advisory Board); and Aim 2(b) implement and evaluate promising solutions—first in a simulated environment (with realistic tasks) and subsequently in a clinical setting. The overall goal of this proposal is to develop a cross-system learning laboratory that brings together older adults, caregivers, researchers, and healthcare teams in innovative ways to protect them from medication harm. Our approach puts the focus on patients and caregivers, with attention to the Social Determinants of Health, and engages them extensively in every step of the systems engineering process. The learning laboratory infrastructure and pilot data from this proposal will create a strong foundation for sustained stakeholder partnership that will spawn future funded studies to improve medication safety for older adults.