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。家庭健康患者中发现的药物数量和药物治疗方案的复杂性给护士和患者带来了重大的管理问题。本研究将进行一项随机试验，以检查两种信息技术（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实践和增强家庭健康患者的患者参与度来促进高质量的护理过渡，这些患者由于正在服用的药物和/或药物治疗方案的复杂性而面临潜在的严重药物问题。临床信息系统，临床医生提醒和护理点的决策支持护士将补充病人量身定制的信息，电子，光盘和硬拷贝格式直接交付给病人的家。“基本”干预将使用一种算法，在服务点提醒家庭健康护士注意可能存在严重药物问题的患者，并为临床医生提供决策支持，包括整合到临床医生访问文档系统和电子患者健康记录中的高风险药物管理建议。“扩大”干预措施将包括针对家庭保健护士的基本干预措施的所有信息技术要素，以及专为在家患者设计并直接提供给患者的信息。该分析将估计基本和增强干预对护理实践和护理过程的影响（例如，决策支持工具的利用、文档的及时性/完整性、与药物相关的通信），关于患者结果（例如，健康状况、药物复杂性、服务使用）和成本。这些因变量的测量将从主要和次要数据的组合中得出。回归模型将用于控制三组（普通、基本、增强）护士之间的差异，这些差异可能会影响护理实践或过程。回归模型还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结果。最后，将估计与每种干预措施和后续护理相关的成本，并在干预措施之间进行比较，并与常规护理进行比较。将描述根据各自的干预措施提供的护理的成本和有效性之间的关系，将这些关系的家庭护理政策和计划举措的影响。

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.