Integrating Pharmacists into an Automated Discharge Process to Promote Comprehensive Medication Management

药师融入自动化出院流程，促进综合用药管理

• 批准号: 10626125
• 负责人: Joel F. Farley
• 金额: $ 45.89万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10626125
• 关键词: Integrating; Pharmacists; into; Automated; Discharge

Project Summary Transitions of care (TOC) from the hospital to primary care setting presents a vulnerable period for the occurrence of adverse drug events (ADEs) which can result in hospital readmission. ADEs are the most common adverse event occurring post-discharge and are often preventable. Given their training and expertise in medications, pharmacists can play a crucial role in improving the safety and quality of care delivered to patients during TOC. When implemented in a consistent, high-fidelity manner, pharmacist-provided comprehensive medication management (CMM) provided outside of the TOC process has been shown to improve hospital readmission rates, clinical outcomes, and health system spending. What remains unknown is how to effectively and efficiently integrate CMM services into TOC workflows in a primary care setting for patients recently discharged from the hospital. Furthermore, the implementation of these processes in a population with high social determinants of health (SDOH) which have significant barriers that may prevent timely follow-up care is systematically understudied in the literature. This study uses an adapted Consolidated Framework for Implementation Research (CFIR) and the RE-AIM model to evaluate the implementation of pharmacist-led CMM in a TOC. To facilitate communication between the hospital and primary care setting, this workflow will utilize an automated electronic alert system (EAS) to notify sites of the need for CMM following a hospital visit. Although studies have examined the effect of implementing an EAS on improvements in care coordination with primary care providers, few studies have utilized EAS to delivery CMM. The research team will conduct this study in collaboration with the Minnesota Federally Qualified Health Center Urban Health Network (FUHN) which operates as the nation’s first safety-net Accountable Care Organization. Aim 1 will identify facilitators and barriers to the implementation and adoption of CMM in a patient-centered TOC workflow. This aim uses a formative evaluation approach to obtain the perspectives of pharmacists, providers, clinic leadership, and care coordinators to uncover barriers and facilitators to the implementation of CMM into TOC workflow. Aim 2 will evaluate the implementation outcomes of implementing CMM into a patient-centered TOC workflow. This aim uses an observational study design with Medicaid claims and electronic health record (EHR) information to examine the reach, adoption, implementation, and maintenance of CMM in TOC employing the RE-AIM model. Aim 3 will focus on the efficacy component of the RE-AIM framework by evaluating the safety and effectiveness outcomes of incorporating CMM into a patient-centered TOC workflow by evaluating the impact of CMM delivery on hospital readmission rates using Medicaid claims data and EHR information. Ultimately, the goal of this research is to generate key learnings that will facilitate the adoption and sustainability of CMM to improve patient safety during TOC. The implementation of this process is expected to result in positive impact on patient safety by decreasing hospital admissions and improving clinical outcomes.

项目摘要 从医院到初级保健环境的护理过渡（TOC）是一个脆弱的时期， 发生可能导致再次入院的药物不良事件（ADE）。ADE是最常见的 常见的不良事件发生在出院后，通常可以预防。鉴于他们的训练和专业知识 在药物治疗方面，药剂师可以在提高医疗服务的安全性和质量方面发挥关键作用， 患者在TOC。当以一致、高保真的方式实施时，药剂师提供的 在TOC过程之外提供的全面药物管理（CMM）已被证明 改善医院再入院率、临床结果和卫生系统支出。目前尚不清楚的是 如何有效地将CMM服务整合到初级保健环境中的TOC工作流程中， 最近出院的病人。此外，在一个 健康的社会决定因素高的人口（SDOH），这些人口有可能阻止 及时的后续护理在文献中系统地研究不足。本研究采用了一种经过调整的综合 实施研究框架（CFIR）和RE-AIM模型，以评估 在TOC中由药剂师领导的CMM。为了促进医院和基层医疗机构之间的沟通， 工作流程将利用自动化电子警报系统（EAS），在以下情况下通知研究中心需要CMM 医院探访虽然研究已经检查了实施EAS对改善护理的影响， 与初级保健提供者的协调，很少有研究利用EAS提供CMM。研究团队 将与明尼苏达州联邦合格健康中心城市健康合作开展这项研究 网络（FUHN），作为全国第一个安全网责任护理组织。目标1将 在以患者为中心的TOC中识别CMM实施和采用的促进因素和障碍 工作流这一目标采用形成性评价方法，以获得药剂师，供应商， 诊所领导和护理协调员，以发现实施CMM的障碍和促进因素， TOC工作流。目标2将评估实施CMM到以患者为中心的 TOC工作流。本研究采用观察性研究设计，包括医疗补助索赔和电子健康记录 (EHR)检查TOC中CMM的范围、采用、实施和维护的信息 采用RE-AIM模型。目标3将侧重于RE-AIM框架的有效性部分， 评价将CMM纳入以患者为中心的TOC工作流程的安全性和有效性结果 通过使用Medicaid索赔数据和EHR评估CMM交付对医院再入院率的影响 信息.最终，这项研究的目标是产生关键的学习，这将有助于采用， CMM的可持续性，以改善TOC期间的患者安全。预计这一进程的实施将 通过减少住院和改善临床结果，对患者安全产生积极影响。