The Secure Messaging for Medication Reconciliation Tool (SMMRT) Trial

药物协调工具安全消息传递 (SMMRT) 试用

• 批准号: 10027247
• 负责人: Amy Linsky
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10027247
• 关键词: Address; Adverse drug event; Adverse event; Area; Caring; Cessation of life; Client satisfaction; Clinical; Collaborations; Communication; Communities; Effectiveness; Electronic Mail; Elements; Emergency department visit; Enrollment; Ensure; Future; Goals; Health; Healthcare; Home environment; Hospitalization; Hospitals; Informatics; Information Technology; Inpatients; Internet; Intervention; Interview; Joints; Lead; Length of Stay; Measures; Mediating; Medical Records; Modeling; Nurses; Outcome Measure; Outpatients; Patients; Pharmaceutical Preparations; Pharmacists; Pilot Projects; Primary Health Care; Primary Nursing Care; Qualitative Methods; Randomized; Randomized Controlled Trials; Reporting; Research; Research Personnel; Secure; Self Efficacy; Testing; Training; Veterans; Visit; arm; base; clinical practice; experience; formative assessment; graphical user interface; health administration; high risk; hospital readmission; hospital utilization; improved; improved outcome; medication administration; novel; patient engagement; patient health information; patient portal; pharmacy benefit; prevent; primary outcome; programs; satisfaction; secondary outcome; tool; treatment as usual; usability

 DESCRIPTION (provided by applicant): Medication discrepancies, defined as unintentional differences found between patients' medical records and patients' reports of the medication they are taking, occur frequently after hospital discharge, predisposing to adverse drug events (ADEs), emergency department visits and readmissions. Resolving medication discrepancies - medication reconciliation - is mandated at every care transition, but little is known about intervention strategies to improve medication reconciliation in the post-discharge period, when patients may lack prompt access to primary care and are at high risk for ADEs. To address this gap, we developed and pilot tested the Secure Messaging for Medication Reconciliation Tool (SMMRT), with a pharmacist communicating with Veterans to review medications and reconcile discrepancies after hospital discharge via Secure Messaging (SM), within My HealtheVet (MHV), VA's patient portal. Our pilot study detected, on average, two clinically important medication discrepancies per Veteran immediately following discharge and demonstrated that Veterans could interact with the pharmacist asynchronously to resolve discrepancies. Veterans found SMMRT easy to use and indicated they would willingly use it again. We therefore propose the SMMRT Trial, in which we will optimize the end-users' experience with SMMRT, conduct a randomized controlled trial (RCT) of MHV training and SMMRT to reduce hospital utilization, and evaluate SMMRT for potential future implementation. For Aim 1, we will conduct formal usability assessment of SMMRT among Veterans (N=10) pharmacists (N=10) and nurses (N=10), refining the user interface for optimal acceptability and effectiveness. For Aim 2, we will mount a 3-arm RCT to evaluate the effects of MHV training and SMMRT, randomizing 1,400 hospitalized Veterans to compare 1) Usual Care (UC), 2) UC + MHV enrollment and training (i.e., "MHV training"), and 3) UC + MHV training + SMMRT after discharge. The primary outcome measure will be 30-day hospital utilization (combined readmissions plus emergency department visits) with the primary hypothesis that SMMRT will reduce hospital utilization compared with UC. For Aim 3, we will carry out a formative evaluation of the interventions for potential future implementation, with qualitative analysis of in-depth interviews from among 20 Veterans and 10-15 primary care nurses. We will collaborate with operational partners: the Veterans' Consumer Health Information Office, which oversees MHV program activities, and the National Medication Reconciliation Initiative, within Pharmacy Benefits Management, responsible for implementing the VA Directive regarding medication reconciliation. If proven effective, SMMRT will have several impacts on Veterans and their health care: 1) decreased medication discrepancies; 2) decreased emergency room visits and hospital readmissions following discharge, which are commonly the result of ADE; 3) improved measures of patient- engagement, patient-centeredness, and patient satisfaction. This study directly supports VA's Transformational Initiative to employ state-of-the-art information technology in the delivery of Veterans' health care.

 描述（由申请人提供）： 用药差异，定义为患者的医疗记录和患者报告的药物之间的意外差异，经常发生在出院后，易发生药物不良事件（ADE），急诊室就诊和再入院。解决药物差异-药物和解-是在每一个护理过渡的任务，但鲜为人知的是，干预策略，以改善药物和解出院后的时期，当患者可能无法及时获得初级保健和ADE的高风险。为了解决这一差距，我们开发并试点测试了药物协调工具的安全消息传递（SMMRT），药剂师与退伍军人沟通，通过安全消息传递（SM）在我的HealthVet（MHV），VA的患者门户网站中审查药物并在出院后协调差异。我们的试点研究发现，平均而言，每个退伍军人出院后立即两个临床上重要的药物差异，并证明退伍军人可以与药剂师异步互动，以解决差异。退伍军人发现SMMRT易于使用，并表示他们愿意再次使用它。因此，我们提出了SMMRT试验，在该试验中，我们将优化最终用户使用SMMRT的体验，进行MHV培训和SMMRT的随机对照试验（RCT）以减少医院利用率，并评估SMMRT未来的潜在实施。对于目标1，我们将在退伍军人（N=10）、药剂师（N =10）和护士（N=10）中进行SMMRT的正式可用性评估，完善用户界面以获得最佳可接受性和有效性。对于目标2，我们将进行一项3组RCT，以评估MHV培训和SMMRT的效果，随机抽取1,400名住院退伍军人，比较1）住院护理（UC），2）UC + MHV入组和培训（即，3）UC + MHV训练+出院后SMMRT。主要结局指标将是30天的医院利用率（合并再入院加急诊科访视），主要假设是SMMRT与UC相比将降低医院利用率。对于目标3，我们将对未来可能实施的干预措施进行形成性评估，并对20名退伍军人和10-15名初级保健护士进行深入访谈的定性分析。我们将与运营伙伴合作：退伍军人消费者健康信息办公室，负责监督MHV计划活动，以及国家药物和解倡议，在药房福利管理中，负责实施VA关于药物和解的指令。如果被证明有效，SMMRT将对退伍军人及其医疗保健产生几种影响：1）减少用药差异; 2）减少出院后急诊室就诊和再入院，这通常是ADE的结果; 3）改善患者参与度，以患者为中心和患者满意度的测量。这项研究直接支持VA的转型计划，采用最先进的信息技术提供退伍军人的医疗保健。