Improving Posthospital Medication Management of Older Adults Through Health IT

摘要 通过健康IT改善老年人的院后药物管理 药物性损伤的发生率在非卧床老年人群中很高， 长者由医院转为日间护理服务时，所需的医疗费会有所增加。在这 应用程序，我们描述了一种努力，以建立在我们丰富的经验，在药物治疗 安全性和基于HIT的药物管理，以响应AHRQ RFA， 门诊安全和质量计划：通过临床医生使用 健康IT（RFA-HS-07 - 006）。在这项研究中，我们建议开发和评估 一个增强的，基于HIT的药物核对系统叠加在 门诊电子病历（EMR），以提高质量和安全 药物管理，特别注重从住院病人到 门诊设置为老年人与多种共病条件谁规定 高风险药物。我们提出了一项基于HIT的随机对照试验， 加强药物协调和治疗的过渡性护理干预 监测警报，以提高患者监测和用药的质量和安全性 管理我们假设，有效和协调地提供可操作的 通过在门诊环境中使用HIT向临床医生提供健康信息， 为日益增长的老年人口提供安全保障。本研究的具体目标 在出院的老年人中， 在过渡到2010年后启动的强化药物核对系统的影响 门诊设置：（1）14天内门诊提供者的随访率 出院率;（2）对选定的高患病率进行适当监测 出院后30天内的风险药物;（3） 出院后30天的药物不良事件（ADE）;（4） 出院后30天内急诊就诊和再次入院。一 本研究的第二个目的是确定与开发直接相关的成本 并实施基于HIT的过渡性护理干预措施。这项研究允许 检查一个综合的HIT干预对随访质量，门诊 临床医生工作流程、ADE发生率和医疗保健利用率，以深入了解 有效使用临床警报和协调提供可操作的信息， 门诊临床医生在管理门诊老年患者后， 出院项目叙述 通过健康IT改善老年人的院后药物管理 美国的老年人每年经历超过1300万次住院治疗， 出院后有近200万例与毒品有关的伤害风险。高效、协调 从住院病人到门诊医生的健康信息传递可以改善 患者监测和药物管理的质量和安全。我们提出了一个随机的 对照试验，以评估基于健康信息技术（HIT）的过渡性护理 通过加强药物核对和监测警报进行干预，以改善药物治疗 为日益增长的老年人口提供安全保障。

Abstract Improving Posthospital Medication Management of Older Adults through Health IT The incidence of drug-induced injury is high in the ambulatory geriatric population and is increased for elders upon transition from the hospital to the ambulatory setting. In this application, we describe an effort to build on our extensive experience in medication safety and HIT-based medication management to respond to the AHRQ RFA entitled Ambulatory Safety and Quality Program: Improving Quality through Clinician Use of Health IT (RFA-HS-07-006). In this study, we propose to develop and evaluate the value of an enhanced, HIT-based medication reconciliation system superimposed on the ambulatory electronic medical record (EMR) to improve the quality and safety of medication management, focusing particularly on the transition from the inpatient to the ambulatory setting for older adults with multiple comorbid conditions who are prescribed high risk medications. We propose a randomized controlled trial of a HIT-based transitional care intervention with enhanced medication reconciliation and therapeutic monitoring alerts to improve the quality and safety of patient monitoring and medication management. We postulate that the efficient and coordinated delivery of actionable health information to the clinician via use of HIT in the ambulatory setting can improve medication safety for the growing geriatric population. The specific aims for this study are to evaluate, among a population of older adults discharged from the hospital, the impact of an enhanced medication reconciliation system initiated upon transition to the ambulatory setting: (1) on the rate of follow-up by an outpatient provider within 14 days of hospital discharge; (2) on the prevalence of appropriate monitoring for selected high risk medications at 30 days from the time of hospital discharge; (3) on the incidence of adverse drug events (ADEs) 30 days after discharge; and (4) on the rate of emergency department visits and hospital readmission within 30 days of discharge. A secondary aim for this study is to determine costs directly related to the development and installation of the HIT-based transitional care intervention. This research allows for the examination of an integrated HIT intervention on the quality of follow-up, outpatient clinician workflow, occurrence of ADEs, and health care utilization to gain insights into the effective use of clinical alerts and coordinated delivery of actionable information to outpatient clinicians in the management of ambulatory elderly patients subsequent to hospital discharge. Project Narrative Improving Posthospital Medication Management of Older Adults through Health IT Older adults in the United States experience over 13 million hospitalizations per year and are at risk for almost 2 million drug-related injuries after discharge. The efficient and coordinated delivery of health information from the inpatient to the outpatient physician can improve the quality and safety of patient monitoring and medication management. We propose a randomized controlled trial to evaluate a health information technology (HIT)-based transitional care intervention with enhanced medication reconciliation and monitoring alerts to improve medication safety for the growing geriatric population.