Multi-Center Medication Reconciliation Quality Improvement Study - MARQUIS

摘要： 护理过渡期间的意外用药差异（例如住院和随后的 出院）是非常常见的，并且对患者安全构成了重大威胁。这个问题的一个解决方案是 药物和解根据联合委员会的要求，大多数医院都制定了 药物协调过程，但有些比其他人更成功，有报告说， 形式上的合规性，而患者安全性没有实质性改善。现在，集体 关于药物协调的有效方法的经验，但这些经验尚未得到巩固， 严格评估，有效传播。 这项研究的广泛，长期目标是优化，广泛实施和评估药物治疗 协调干预措施，以改善病人在护理过渡期间的安全。具体目标是：1） 开发一个工具包，整合目前关于药物协调的最佳做法建议; 2）开展 一个多中心指导的质量改进项目，其中每个站点都根据自己的需要调整工具 环境，并实施它们，以在药物的几个方面取得可衡量的进展 协调过程; 3）评估该干预措施对意外用药差异的影响;以及 4)进行严格的项目评估，以确定干预措施的最重要组成部分， 如何最好地实施它。 根据最近一次药物协调会议的专家建议， 由医院医学协会和AHRQ资助，研究人员将聘请一个指导委员会， 举行第二次会议，将这些建议落实为一套“最佳做法”准则， 标准和工具，由6个参与站点中的每一个进行调整。在培训导师和开发数据之后 收集工具，将进行为期21个月的指导质量改进项目，其中每个网站 利用工具包和两次现场访问的指导，努力改善药物协调 每月电话。研究中心将在以下方面获得数据收集方面的协助，包括数据收集工具- 现场使用培训，第二次访问，以确保可靠的数据收集。非故意用药 将使用中断时间序列方法每月分析入院和出院时的差异， 跟踪干预的各个方面随时间的影响，并根据时间趋势和地点进行调整， 具体效果。项目评估将采用定性和定量相结合的方法进行， 了解有助于成功实现药物协调目标的因素。 该项目的研究结果将为所有医院提供关于设计和 实施药物协调干预措施，以改善护理过渡期间的药物安全。

Abstract: Unintentional medication discrepancies during transitions in care (such as hospitalization and subsequent discharge) are very common and represent a major threat to patient safety. One solution to this problem is medication reconciliation. In response to Joint Commission requirements, most hospitals have developed medication reconciliation processes, but some have been more successful than others, and there are reports of pro-forma compliance without substantial improvements in patient safety. There is now collective experience about effective approaches to medication reconciliation, but these have yet to be consolidated, evaluated rigorously, and disseminated effectively. The broad, long-term objective of this research is to optimize, widely implement, and evaluate medication reconciliation interventions that improve patient safety during transitions in care. The specific aims are to: 1) develop a toolkit consolidating current best practice recommendations for medication reconciliation; 2) conduct a multi-center mentored quality improvement project in which each site adapts the tools for its own environment and implements them to make measurable progress in several facets of the medication reconciliation process; 3) assess the effects of this intervention on unintentional medication discrepancies; and 4) conduct rigorous program evaluation to determine the most important components of the intervention and how best to implement it. Based on expert recommendations from a recent conference on medication reconciliation sponsored by the Society of Hospital Medicine and funded by AHRQ, investigators will engage a steering committee and conduct a second conference to operationalize these recommendations into a set of "best practice" guidelines, standards, and tools to be adapted by each of 6 participating sites. After training mentors and developing data collection tools, a mentored quality improvement project will be conducted for 21 months, in which each site works to improve medication reconciliation using the toolkit and with mentorship in the form of two site visits and monthly phone calls. Sites will be given assistance with data collection, including data collection tools, on- site training in their use, and a second visit to ensure reliable data collection. Unintentional medication discrepancies at admission and discharge will be analyzed monthly using interrupted time-series methods to track the effects of the individual facets of the intervention over time, adjusted for temporal trends and site- specific effects. Program evaluation will be conducted using mixed qualitative and quantitative methods in order to understand factors that contribute to successfully achieving medication reconciliation goals. This project's findings will provide valuable lessons to all hospitals regarding the best ways to design and implement medication reconciliation interventions to improve medication safety during transitions in care.