Improving Medication Management Practices and Care Transitions through Technology

描述（由申请人提供）：家庭健康组织为以多种慢性疾病为特征的主要医疗保险人群提供急性后护理。在家庭保健患者中发现的药物数量和药物治疗方案的复杂性对护士和患者都构成了重大的管理问题。本研究将进行一项随机试验，以检验两种信息技术（IT）干预措施（“基本”和“增强”）的有效性和成本效益，旨在通过改善临床医生的实践和增强家庭健康患者的参与，促进高质量的护理过渡，这些患者由于正在服用的药物和/或药物方案的复杂性而面临潜在严重药物问题的风险。临床信息系统、临床医生提醒和护士护理点决策支持将由电子、CD和硬拷贝格式的患者定制信息直接发送到患者家中。“基本”干预将使用一种算法，在服务点提醒家庭健康护士，病人有潜在的严重药物问题风险，并为临床医生提供决策支持，包括高风险药物管理建议，这些建议被整合到临床医生的访问文件系统和电子患者健康记录中。“增强型”干预将包括针对家庭保健护士的基本干预的所有信息技术要素，以及为在家的病人设计并直接提供给他们的信息。分析将评估基本和增强干预措施对护理实践和护理过程（例如，决策支持工具的使用、文件的及时性/完整性、药物相关通信）、患者结果（例如，健康状况、药物复杂性、服务使用）和成本的影响。对这些因变量的测量将从一手数据和二手数据的组合中得出。回归模型将用于控制三组（普通、基本、增强）护士在可能影响护理实践或过程的特征方面的差异。回归模型也将用于控制患者群体之间的差异，这些差异可能会影响护士的药物管理或患者的健康和药物相关的结果。最后，将评估与每项干预措施和后续护理相关的成本，并将其与不同干预措施和常规护理相比较。将描述在各自干预措施下提供的护理的成本和有效性之间的关系，以及这些关系对家庭护理政策和计划倡议的影响。

DESCRIPTION (provided by the applicant): Home health organizations provide post-acute care to a predominantly Medicare population characterized by multiple chronic conditions. The number of drugs and complexity of medication regimens found among home health patients pose significant management problems for both nurses and patients. This study will conduct a randomized trial to examine the effectiveness and cost-effectiveness of two information technology (IT) interventions ("basic" and "augmented") aimed at facilitating high quality care transitions through improved clinician practice and enhanced patient engagement among home health patients at risk of a potentially serious medication problem due to the drugs they are taking and/or the complexity of their medication regimens. Clinical information systems, clinician reminders and point-of-care decision support for nurses will be complemented by patient-tailored information in electronic, CD and hard copy formats delivered directly to the patient's home. The "basic" intervention will use an algorithm to alert the home health nurse, at the point of service, to a patient at risk of a potentially serious medication problem and provides the clinician with decision support, including high-risk medication management recommendations that are integrated into the clinician's visit documentation system and the electronic patient health record. The "augmented" intervention will include all the IT elements of the basic intervention targeted to the home health nurse plus information designed for and directly delivered to patients at home. The analysis will estimate the impact of the basic and augmented interventions on nursing practices and processes of care (e.g., utilization of decision support tools, timeliness/ completeness of documentation, medication-related communications), on patient outcomes (e.g., health status, medication complexity, service use), and on costs. Measures of these dependent variables will be derived from a combination of primary and secondary data. Regression models will be used to control for differences among nurses in the three groups (usual, basic, augmented) with respect to characteristics that might influence practices or processes of care. Regression models also will be used to control for differences across patient groups that might influence nurses' medication management or patients' health and medication-related outcomes. Finally, the costs associated with each of the interventions and subsequent care will be estimated and compared across interventions and relative to usual care. The relationships between costs and effectiveness of care delivered under the respective interventions will be described, as will the implications of these relationships for home care policy and program initiatives.