Improving Posthospital Medication Management of Older Adults Through Health IT

NCT ID: NCT00611091

Last Updated: 2013-09-16

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 5077 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2010-08-31
• Study Completion Date: 2013-09-30

Brief Summary

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 transitional care intervention 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 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 discharge information 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.

Conditions

Adverse Outcomes Post-hospital Discharge

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: SINGLE

Study Groups

I

Intervention Group - (receive intervention) randomized at patient level - includes all health plan members, aged 65+, hospitalized at the study site hospital and discharged to an outpatient health plan clinic provider.

Group Type: EXPERIMENTAL

Electronic delivery of enhanced discharge information to the ambulatory physician

Intervention Type: OTHER

Follow-up appointment needs/plans

Electronic delivery of enhanced discharge information to the ambulatory physician

Intervention Type: OTHER

Laboratory follow-up needs

Electronic delivery of enhanced discharge information to the ambulatory physician

Intervention Type: OTHER

New medications

C

Control Group - (do not receive intervention) randomized at patient level - includes all health plan members, aged 65+, hospitalized at the study site hospital and discharged to an outpatient health plan clinic provider.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Electronic delivery of enhanced discharge information to the ambulatory physician

Follow-up appointment needs/plans

Intervention Type: OTHER

Electronic delivery of enhanced discharge information to the ambulatory physician

Laboratory follow-up needs

Intervention Type: OTHER

Electronic delivery of enhanced discharge information to the ambulatory physician

New medications

Intervention Type: OTHER

Other Intervention Names

HIT; HIT; HIT

Eligibility Criteria

Inclusion Criteria

• 65+ years old, member of the study site health plan, hospitalized at the study site hospital, discharged to an outpatient provider at the study site health plan clinic

• Minimum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Fallon Clinic

INDUSTRY

Sponsor Role: collaborator

Agency for Healthcare Research and Quality (AHRQ)

FED

Sponsor Role: collaborator

University of Massachusetts, Worcester

OTHER

Sponsor Role: lead

Responsible Party

Jerry Gurwitz

Chief, Division of Geriatric Medicine

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Jerry H Gurwitz, MD

Role: PRINCIPAL_INVESTIGATOR

Meyers Primary Care Institute/University of Massachusetts Medical School

Locations

St Vincent's Hospital

Worcester, Massachusetts, United States

Countries

United States

Other Identifiers

1R18HS017203

Identifier Type: AHRQ

Identifier Source: secondary_id

View Link

12603

Identifier Type: -

Identifier Source: org_study_id