Improving Medication Management Practices and Care Transitions through Technology

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DESCRIPTION (provided by the applicant): Home health organizations provide post-acute care to a predominantly Medicare population characterized by multiple chronic conditions. The number of drugs and complexity of medication regimens found among home health patients pose significant management problems for both nurses and patients. This study will conduct a randomized trial to examine the effectiveness and cost-effectiveness of two information technology (IT) interventions ("basic" and "augmented") aimed at facilitating high quality care transitions through improved clinician practice and enhanced patient engagement among home health patients at risk of a potentially serious medication problem due to the drugs they are taking and/or the complexity of their medication regimens. Clinical information systems, clinician reminders and point-of-care decision support for nurses will be complemented by patient-tailored information in electronic, CD and hard copy formats delivered directly to the patient's home. The "basic" intervention will use an algorithm to alert the home health nurse, at the point of service, to a patient at risk of a potentially serious medication problem and provides the clinician with decision support, including high-risk medication management recommendations that are integrated into the clinician's visit documentation system and the electronic patient health record. The "augmented" intervention will include all the IT elements of the basic intervention targeted to the home health nurse plus information designed for and directly delivered to patients at home. The analysis will estimate the impact of the basic and augmented interventions on nursing practices and processes of care (e.g., utilization of decision support tools, timeliness/ completeness of documentation, medication-related communications), on patient outcomes (e.g., health status, medication complexity, service use), and on costs. Measures of these dependent variables will be derived from a combination of primary and secondary data. Regression models will be used to control for differences among nurses in the three groups (usual, basic, augmented) with respect to characteristics that might influence practices or processes of care. Regression models also will be used to control for differences across patient groups that might influence nurses' medication management or patients' health and medication-related outcomes. Finally, the costs associated with each of the interventions and subsequent care will be estimated and compared across interventions and relative to usual care. The relationships between costs and effectiveness of care delivered under the respective interventions will be described, as will the implications of these relationships for home care policy and program initiatives.