药物协调工具安全消息传递 (SMMRT) 试用-猫眼课题宝

药物协调工具安全消息传递 (SMMRT) 试用

批准号：

9145515

负责人：

STEVEN R. SIMON

金额：

$0.0万

依托单位：

VA BOSTON HEALTH CARE SYSTEM

依托单位国家：

美国

项目类别：

财政年份：

2015

资助国家：

美国

项目状态：

已结题

起止时间：

2015-07-01 至 2019-09-30

来源：

https://reporter.nih.gov/project-details/9145515

关键词：

Address Address Admission activity Adverse drug event Adverse drug event Adverse event Adverse event Area Area Caring Caring Cessation of life Cessation of life Client satisfaction Client satisfaction Clinical Collaborations Collaborations Communication Communication Communities Communities Effectiveness Effectiveness Electronic Mail Electronic Mail Elements Elements Emergency department visit Emergency department visit Enrollment Enrollment Ensure Ensure Future Future Goals Goals Health Health Healthcare Healthcare Home environment Home environment Hospitalization Hospitalization Hospitals Hospitals Informatics Informatics Information Technology Information Technology Inpatients Inpatients Internet Internet Intervention Intervention Interview Interview Joints Joints Lead Lead Length of Stay Measures Measures Mediating Mediating Medical Records Medical Records Modeling Modeling Nurses Nurses Outcome Measure Outcome Measure Outpatients Outpatients Patient Discharge Patients Patients Pharmaceutical Preparations Pharmaceutical Preparations Pharmacists Pharmacists Pilot Projects Pilot Projects Primary Health Care Primary Health Care Primary Nursing Care Primary Nursing Care Qualitative Methods Qualitative Methods Randomized Randomized Randomized Controlled Trials Randomized Controlled Trials Reporting Reporting Research Research Research Personnel Research Personnel Secure Secure Self Efficacy Self Efficacy Testing Testing Training Training Veterans Veterans Visit Visit arm arm base base clinical practice clinical practice experience experience formative assessment formative assessment graphical user interface graphical user interface health administration health administration high risk high risk hospital readmission hospital readmission hospital utilization hospital utilization improved improved improved outcome improved outcome medication administration novel novel patient engagement patient portal pharmacy benefit pharmacy benefit prevent prevent primary outcome primary outcome programs programs satisfaction secondary outcome secondary outcome tool tool treatment as usual treatment as usual usability usability

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中文摘要

翻译

描述(由申请人提供)：用药差异是指患者的医疗记录和患者对他们正在服用的药物的报告之间发现的无意差异，在出院后经常发生，容易发生不良药物事件(ADE)、急诊科就诊和再次入院。每次护理过渡都要求解决用药差异--用药协调，但对出院后改善用药协调的干预策略知之甚少，因为在出院后，患者可能无法及时获得初级保健，并面临ADE的高风险。为了弥补这一差距，我们开发并试点测试了药物安全消息传递对账工具(SMMRT)，药剂师与退伍军人进行沟通，通过安全消息传递(SM)在退伍军人管理局的患者门户My HealtheVet(MHV)内审查药物并协调出院后的差异。我们的初步研究平均检测到每个退伍军人在出院后立即有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来解决差异。退伍军人发现SMMRT很容易使用，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对SMMRT的体验，对MHV培训和SMMRT进行随机对照试验(RCT)，以减少医院使用率，并评估SMMRT未来实施的可能性。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，以优化用户界面，以实现最佳的接受性和有效性。对于目标2，我们将建立一个三臂随机对照试验来评估MHV培训和SMMRT的效果，随机选择1,400名住院退伍军人进行比较：1)常规护理(UC)，2)UC+MHV登记和培训(即“MHV培训”)，以及3)UC+MHV培训+出院后SMMRT。主要的结果衡量标准将是30天的医院利用率(再入院加急诊科就诊)，主要假设是SMMRT与UC相比将减少医院利用率。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名初级保健护士的深入访谈进行定性分析。我们将与业务合作伙伴合作：负责监督MHV计划活动的退伍军人消费者健康信息办公室，以及药房福利管理中负责执行退伍军人管理局关于药物调节的指令的全国药物调节倡议。如果被证明有效，SMMRT将对退伍军人及其医疗保健产生几个影响：1)减少用药差异；2)减少急诊室就诊和出院后再次住院，这通常是ADE的结果；3)改进了患者参与度、以患者为中心和患者满意度的衡量标准。这项研究直接支持退伍军人管理局的转型计划，即在提供退伍军人医疗保健时使用最先进的信息技术。

英文摘要

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.

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