Implementing A Regional Data Exchange Tool To Improve Medication Use And Safety

项目背景：药物对账是一个过程，提供者通过这个过程获得并记录完整的用药历史，特别注意比较当前和以前的用药情况，可以防止与药物有关的错误和伤害。有效的药物调节的最重要的信息障碍是患者自己关于他们用药的报告的不可靠性和提供者不完整的病历记录。James J.Peters VA(JJP VA)是Bronx RHIO的原始参与机构，Bronx RHIO是纽约州资助的医疗信息交换组织，于2008年10月在Bronx最大的医疗保健提供者之间实施了安全的临床数据信息交换。JJP VA提供商现在可以从非VA设施访问关键临床数据，包括药物使用 征得病人同意。这为开发利用实时非退伍军人用药数据来减少退伍军人不良药物事件的药物审查过程提供了一个研究机会。它还提供了一个机会来检查与将RHIO接入纳入VA提供商的日常工作流程有关的实施因素。我们认为，从退伍军人管理局以外常规获取药物信息有可能防止有害的药物差异和组合，防止不良药物事件(ADE)，并降低退伍军人的住院费用。 项目目标：1)调整药物调节程序，使之包括来自区域健康信息交换(RHIO)的信息；2)利用区域健康信息交换的数据，对入院时的药物调节过程进行增强或不增强的对照试验，并检查对过渡药物风险、不良药物事件和总住院费用的影响；以及3)确定阻碍和促进退伍军人管理局采用信息交换工具常规使用的系统和提供者因素。 项目方法：我们将进行定性和定量研究。首先，我们将执行认知任务分析(CTA)来检查提供商的决策，并在提供商与RHIO工具交互时映射RHIO工具的功能，并通过访谈问题确定促进或阻碍使用的因素。其次，我们将登记住在JJP VA的两个住院单元的患者，并将他们分配到接受常规药物调节或RHIO增强药物调节的患者，并向医生通知患者的非VA服务，可以在RHIO中查看。我们将通过病历审查和患者访谈来衡量过渡药物的风险和不良反应，并使用来自国家VA数据集的行政成本数据来衡量住院成本。第三，我们将在定量研究结束时与药剂师和医生进行CTA，他们是使用该工具的专家，以表征与定量研究之前的认知过程的差异。这将提供有关阻碍和促进采用该工具进行日常使用的系统和供应商因素的信息，以及有关潜在应用的信息 该工具的改进。

Project Background: Medication reconciliation, a process by which a provider obtains and documents a thorough medication history with specific attention to comparing current and previous medication use, can prevent medication-related errors and harm. The most important information-related barrier to effective medication reconciliation is the unreliability of patients' own reports about their medication use and incomplete provider history-taking. The James J. Peters VA (JJP VA) is an original participating facility in the Bronx RHIO, a New York State-funded health information exchange organization that in October 2008 implemented secure clinical data information exchange among the largest healthcare providers in the Bronx. JJP VA providers can now access key clinical data, including medication use, from non-VA facilities with patients' consent. This presents a research opportunity to develop a medication review process that takes advantage of real-time non-VA medication use data to reduce adverse drug events in veterans. It also provides an opportunity to examine implementation factors regarding incorporating RHIO access into everyday workflow for VA providers. We posit that routine access to medication information from outside the VA has the potential to prevent harmful drug discrepancies and combinations, to prevent adverse drug events (ADEs), and reduce inpatient costs in veterans. Project Objectives: 1) To adapt a medication reconciliation process to include information from a regional health information exchange (RHIO), 2) To conduct a controlled trial of a medication reconciliation process at the time of hospital admission either enhanced or not enhanced with data from a regional health information exchange, and examine effects on transition drug risk, adverse drug events, and total inpatient costs, and 3) To identify system and provider factors that impede and facilitate adoption of the information exchange tool for routine use by VA providers. Project Methods: We will conduct qualitative and quantitative studies. First we will perform cognitive task analysis (CTA) to examine providers' decision-making and to map RHIO tool functions while providers interface with the tool, with interview questions to identify factors that facilitate or hinder use. Second we will enroll patients admitted to 2 inpatient units at the JJP VA, and assign them to receive usual medication reconciliation or RHIO-enhanced medication reconciliation with a notification to physicians about the patient's non-VA services that can be viewed in the RHIO. We will measure transition drug risk and ADEs by medical record review and patient interview, and measure inpatient costs with administrative cost data from national VA datasets. Third, we will conduct CTA with pharmacists and physicians at the end of the quantitative study who are expert in use of the tool to characterize differences in cognitive processes from prior to the quantitative study. This will supply information on system and provider factors that impede and facilitate adoption of the tool for routine use, and on potential improvements in the tool.