Patient-Driven Medication Safety Learning Laboratory in Care Transitions

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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.