Leveraging a Social Network of Elders and Families To Improve Medication Safety at Transitions of Care

项目摘要 患者和他们的家人经常难以管理药物，特别是在护理过渡期间。 出院后发生的所有不良事件中，有三分之二与药物有关。问题是 对于经常服用多种药物的老年患者，药物管理被放大 副作用和药物与药物的相互作用可能会导致更多的危害。 InfoSAGE(跨代信息共享)是AHRQ支持的现有研究项目， 旨在了解和解决75岁及以上老年人的信息和护理协调需求， 以及参与照顾他们的家人。研究参与者使用在线私人社交网络， 为项目构建的(https://www.infosagehealth.org)，，用于查找资源并管理任务和通信。 我们的方法以一种新的方式使用卫生信息技术，创建了一个基于社区的平台 改善护理协调、患者和家庭赋权，并最终提高患者安全。 在这个项目中，我们建议扩展InfoSAGE平台的功能，以包括移动优先/点- 护理用药经理，帮助老年人及其家人保持准确的用药清单， 与处方临床医生协调列表，跟踪药物对症状的影响，查看 药物预防和药物-药物相互作用，并作为伙伴更多地参与到他们的护理中。 我们将确定使用共享在线药物清单的促进者和障碍，评估可用性和 工具所需的电子健康素养，并衡量其采用和使用情况。然后，我们将研究 关于用药安全的工具，并确定增加对该工具的参与是否会改善共同决策- 关于药物的使用，减少药物和多药联用的不当使用。 我们的长期目标是开发一套使用在线和移动工具来应对复杂情况的最佳实践 药物管理。

Project Summary Patients and their families often have difficulty managing medications, especially across transitions of care. Two-thirds of all adverse events following hospital discharge are related to medications. The problem of medication management is magnified for older patients, who are often on multiple medications and for whom side effects and drug-drug interactions may lead to more harm. InfoSAGE (Information Sharing Across Generations) is an existing AHRQ-supported research project that seeks to understand and address information and care coordination needs of older adults, age 75 and above, and their families who are involved in their care. Research participants use an online private social network, built for the project (https://www.infosagehealth.org), to find resources and manage tasks and communications. Our approach uses health information technology in a new way, creating a community-based platform to improve care coordination, patient and family empowerment, and ultimately improve patient safety. In this project, we propose to expand the functionality of the InfoSAGE platform to include a mobile-first/point- of-care medication manager to help elderly people and their families keep an accurate medication list, coordinate the list with the prescribing clinicians, track the impact of medications on symptoms, view medication precautions and drug-drug interactions, and become more engaged as partners in their care. We will determine facilitators and barriers to the use of a shared online medication list, assess the usability and e-Health literacy needed for the tool, and measure its adoption and usage. We will then study the impact of the tool on medication safety and determine if increased engagement with the tool improves shared decision- making about medications and reduces the inappropriate use of medications and polypharmacy. Our long-term goal is to develop a set of best practices for the use of online and mobile tools for complex medication management.