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Minimizing Errors in Medication Histories Obtained at Hospital Admission

最大限度地减少入院时获得的用药史的错误

基本信息

批准号：
9232962
负责人：
Joshua M Pevnick
金额：
$ 20.21万
依托单位：
CEDARS-SINAI MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-08-01 至 2019-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9232962
关键词：
Accident and Emergency department Address Admission activity Adverse drug event Affect Aging Appointment Biometry Caregivers Caring Cessation of life Chiroptera Clinical Clinical Trials Design Complex Data Discipline of Nursing Doctor of Pharmacy Doctor of Philosophy Elderly Electronic Health Record Equilibrium Exclusion Foundations Funding Geriatrics Goals Government Health Services Health Services Research Health system Healthcare Healthcare Systems Home environment Hospitals Human Resources Incentives Informatics Information Technology Injury Internist Intervention Intervention Studies Lead Learning Measures Medical Medical Informatics Medical Records Medication Errors Medication Management Medicine Mentors Methodology Methods Morbidity - disease rate Nurses Older Population Patients Pharmaceutical Preparations Pharmacists Pharmacologic Substance Pharmacy facility Phonation Physicians Physiological Process Provider Public Health Randomized Controlled Trials Recording of previous events Records Regimen Research Research Personnel Research Project Grants Research Proposals Retrospective Studies Science Suggestion Supervision Telephone Testing Time Training Training Support Work base career career development cost cost effective cost efficient design electronic data improved meetings mortality older patient prevent professor public health relevance therapy design trial design ward

项目摘要

DESCRIPTION (provided by applicant): Joshua Pevnick, MD, MSHS is a general internist with Assistant Professor appointments at Cedars-Sinai Health System (CSHS) and UCLA. He practices hospital medicine and has been conducting health services research (HSR) focusing on information technology interventions to improve medication management. Recently, he has seen that those likely to benefit most from his work are older adults, as they have the most complex medication regimens, the least ability to remember these regimens, and the least physiologic reserve to tolerate adverse drug events. Furthermore, almost all of his clinical work and research is conducted at CSHS, which is known to have a disproportionately older population. Finally, this issue is best addressed in a patient-centric, rather than solution-centri, manner. For all of these reasons, further geriatric training would substantially benefit his research. He has thus recently changed his career goal to: Become a leading health services researcher advancing the study of medication management in seniors at care transitions. To achieve this goal, Dr. Pevnick proposes a mentoring plan involving regular meetings with four mentors: Douglas Bell, MD, PhD (content expertise in informatics, methodological expertise in HSR), Catherine Sarkisian, MD, MSPH (content expertise in geriatrics, methodological expertise in HSR), Cynthia Jackevicius, PharmD (content expertise in pharmaceutical sciences, methodological expertise in HSR), and Andre Rogatko, PhD (methodological expertise in biostatistics and trial design). His career development will also be supported by training plans emphasizing geriatrics, clinical trial design, grantwriting and medical informatics. Finally, he wil conduct a research project to generate results important for their own sake, to serve as a vehicle to apply what he learns from mentors and classes, and to build a foundation for future research proposals. Dr. Pevnick proposes to study three interventions to improve the accuracy of medication histories obtained at hospital admission. The interventions will target older adult patients prone to erroneous medication histories and concomitant medication errors. For predominantly older patients on complex home medication regimens, Dr. Pevnick is conducting a randomized controlled trial (RCT) to test the effect of using pharmacists and pharmacy technicians to obtain an initial admission medication history (AMH) on its accuracy. He will retrospectively study the potential benefit of accessing electronic medication fill data at the tim of admission to improve AMH accuracy. After analyzing both how these interventions affect AMH accuracy and the labor costs for these interventions, Dr. Pevnick will lead the design and refinement of a combined intervention targeted at seniors, which will ultimately be tested in a second RCT. Improving AMH accuracy is accepted as a necessary first step in preventing adverse drug events, which cause over 100,000 deaths in hospitalized US patients annually. Beyond studying potential solutions to this public health threat, this research project will provid Dr. Pevnick the opportunity to develop himself into a leading independent investigator in aging science.

描述（由申请人提供）：Joshua Pevnick， MD， MSHS是雪松-西奈卫生系统（CSHS）和加州大学洛杉矶分校的助理教授任命的普通内科医生。他从事医院医学工作，并一直从事卫生服务研究（HSR），专注于信息技术干预以改善药物管理。最近，他发现最可能从他的工作中受益的是老年人，因为他们有最复杂的药物治疗方案，记忆这些方案的能力最低，而且对药物不良事件的生理储备最低。此外，他几乎所有的临床工作和研究都是在CSHS进行的，众所周知，CSHS的老年人口比例过高。最后，这个问题最好以病人为中心，而不是以解决方案为中心。由于所有这些原因，进一步的老年培训将大大有利于他的研究。因此，他最近改变了他的职业目标：成为一名领先的卫生服务研究人员，推进老年人在护理过渡期间的药物管理研究。为了实现这一目标，Pevnick博士提出了一项指导计划，包括与四位导师定期会面：Douglas Bell，医学博士，博士（信息学内容专业知识，HSR方法专业知识），Catherine Sarkisian，医学博士，MSPH（老年病学内容专业知识，HSR方法专业知识），Cynthia Jackevicius，药学博士（药学内容专业知识，HSR方法专业知识），Andre Rogatko，博士（生物统计学和试验设计方法专业知识）。他的职业发展也将得到培训计划的支持，重点是老年病学、临床试验设计、拨款撰写和医学信息学。最后，他将进行一个研究项目，以产生对他们自己来说很重要的结果，作为一种工具，应用他从导师和课堂上学到的东西，并为未来的研究计划奠定基础。Pevnick博士建议研究三种干预措施，以提高入院时获得的用药史的准确性。干预措施将针对有错误用药史和伴随用药错误倾向的老年成人患者。对于主要采用复杂家庭用药方案的老年患者，Pevnick博士正在进行一项随机对照试验（RCT），以测试使用药剂师和药房技术人员获取初始入院用药史（AMH）对其准确性的影响。他将回顾性研究在入院时访问电子药物填写数据以提高AMH准确性的潜在益处。在分析了这些干预措施如何影响AMH的准确性以及这些干预措施的人工成本之后，Pevnick博士将领导针对老年人的联合干预措施的设计和改进，最终将在第二项随机对照试验中进行测试。提高AMH的准确性被认为是预防药物不良事件的必要第一步，药物不良事件每年导致美国住院患者超过10万人死亡。除了研究这一公共健康威胁的潜在解决方案之外，这个研究项目还将为佩夫尼克博士提供一个机会，使他成为衰老科学领域领先的独立研究者。