权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

A Multicenter RCT of Pharmacist-Directed Transitional Care to Reduce Post-Hospitalization Utilization

药剂师指导的过渡护理以减少出院后使用的多中心随机对照试验

基本信息

批准号：
10215377
负责人：
Joshua M Pevnick
金额：
$ 69.57万
依托单位：
CEDARS-SINAI MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-01 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10215377
关键词：
Address Adopted Adverse drug event Adverse event American Budgets Businesses Caring Cessation of life Clinical Research Communities Complex Counseling Country Disease Management Dissemination and Implementation Doctor of Pharmacy Doctor of Philosophy Drug Prescriptions Economics Elderly Emergency department visit Ensure Face Funding Geriatrics Goals Grant Health Health Care Costs Health system Hospitalization Hospitals Human Resources Institution Intervention Knowledge Lead Light Literature Measures Medical Medication Errors Medication Management Methodology Methods Modeling Monitor Morbidity - disease rate Older Population Organizational Change Outcome Outpatients Patients Pharmaceutical Preparations Pharmacists Pharmacy facility Physiological Polypharmacy Prevalence Process Publishing Qualitative Methods Randomized Controlled Trials Reach, Effectiveness, Adoption, Implementation, and Maintenance Regimen Reporting Research Research Personnel Resources Review Literature Risk Sample Size Secondary to Services Site Societies Surrogate Endpoint Telephone Testing Time Training Update attributable mortality cost design evidence base experience health care service utilization high risk hospital readmission implementation cost improved information organization innovation intervention effect member mortality multidisciplinary patient subsets pragmatic trial prevent randomized trial side effect social success

项目摘要

The sickest patients in the community are recently hospitalized elders. A substantial component of their morbidity and mortality is caused by adverse drug events (ADEs). ADEs account for 70% of adverse events occurring after discharge, which occur at a rate of 0.30 ADEs per patient. The oldest, sickest patients are at highest risk for ADEs because they have the most complex and hazardous medication regimens yet the least physiologic reserve and the fewest social and economic resources. Several studies, including our own, have demonstrated the efficacy of pharmacist-led post-discharge interventions to improve medication management. Most prominent among these have been post-discharge phone calls from pharmacists to patients. However, despite demonstrated efficacy, these interventions have not been widely implemented. In this proposal, we use the RE-AIM model to understand and address gaps in existing research that have hindered implementation. The central knowledge gap is that most research focuses on process or surrogate endpoint measures (like medication discrepancies) that we now understand to be insufficient to motivate organizational change. In contrast, we will measure the effect on utilization, a closely-tracked outcome that strongly motivates hospital leaders. We will use a large randomized controlled trial to rigorously assess the effect of PHARM-DC on this outcome. We will also study the barriers and facilitators of adopting these interventions, about which little is known. Finally, although implementation costs are critically important information for organizations considering pharmacist-led discharge (PHARM-DC) interventions, evidence on this topic is scarce. We thus aim to measure the impact of PHARM-DC interventions on post-discharge utilization within 30 days. We will also identify patient sub-populations most likely to benefit from PHARM-DC. Finally, we will estimate the incremental net cost of PHARMs from the health system perspective. To study these aims, we have selected two sites that: 1) are already proficient at in-hospital medication reconciliation, a prerequisite for implementing and evaluating PHARM-DC; 2) have a Chief Pharmacy Officer committed to using operational resources to provide PHARM-DC to patients during the study period; and 3) have investigators experienced in the research content and methodologies needed to study the aforementioned aims. This project will generate new knowledge allowing for increased implementation and dissemination of research already known to be efficacious, thus reducing the substantial morbidity and mortality attributable to ADEs among seniors in the high risk post-discharge time period.

社区中病情最严重的病人是最近住院的老年人。的重要组成部分