Multi-Center Medication Reconciliation Quality Improvement Study

NCT ID: NCT01337063

Last Updated: 2015-11-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

1836 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-03-31

Study Completion Date

2014-09-30

Brief Summary

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Patients often have problems after they leave the hospital, in part because errors are made in the medications they are prescribed. The goal of this project is to develop a more accurate and safe medication prescription process when patients enter and leave the hospital and implement this process at six U.S. hospitals. The investigators will measure the success of the project and develop lessons learned so this process can be applied to other hospitals.

Detailed Description

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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.

This project's findings should 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.

SPECIFIC AIMS:

Aim 1: Develop a toolkit consolidating the best practice recommendations for medication reconciliation

Aim 2: Conduct a multi-center mentored quality improvement project in which each site adapts the tools for its own environment and implements them

Aim 3: Assess the effects of a mentored medication reconciliation quality improvement intervention on unintentional medication discrepancies with potential for patient harm

Aim 4: Conduct rigorous program evaluation to determine the most important components of a medication reconciliation program and how best to implement it

Conditions

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Adverse Drug Events Medication Administered in Error

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Pre-intervention

Usual care regarding medication reconciliation as currently practiced at each participating site.

Group Type NO_INTERVENTION

No interventions assigned to this group

Intervention

Improved medication reconciliation process using continuous quality improvement methods, mentored implementation, and an implementation guide.

Group Type EXPERIMENTAL

Mentored medication reconciliation quality improvement

Intervention Type OTHER

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.

Interventions

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Mentored medication reconciliation quality improvement

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.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Age 18 and over
* Admitted to inpatient medical or surgical services

Exclusion Criteria

* Vulnerable populations (pregnant women, prisoners, institutionalized individuals)
* Under 18 years

Hospital staff subjects:

* Personnel directly involved in the medication reconciliation process, which depending on the site might include residents, physician assistants, inpatient attending physicians, nurses, pharmacists, and pharmacy technicians.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Society of Hospital Medicine

OTHER

Sponsor Role collaborator

Vanderbilt University

OTHER

Sponsor Role collaborator

University of Wisconsin, Madison

OTHER

Sponsor Role collaborator

University of California, San Francisco

OTHER

Sponsor Role collaborator

Baystate Health

OTHER

Sponsor Role collaborator

University of Chicago

OTHER

Sponsor Role collaborator

Presbyterian Hospital, Charlotte

UNKNOWN

Sponsor Role collaborator

Sioux Falls VA Health Care System

FED

Sponsor Role collaborator

Emory Johns Creek Hospital

UNKNOWN

Sponsor Role collaborator

Brigham and Women's Hospital

OTHER

Sponsor Role lead

Responsible Party

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Jeffrey L. Schnipper, MD.,MPH.

Associate Professor of Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Jeffrey L Schnipper, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

Brigham and Women's Hospital

Locations

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University of California, San Francisco

San Francisco, California, United States

Site Status

Emory Johns Creek Hospital

Johns Creek, Georgia, United States

Site Status

University of Chicago Hospitals and Clinics

Chicago, Illinois, United States

Site Status

Baystate Health

Springfield, Massachusetts, United States

Site Status

Presbyterian Hospital

Charlotte, North Carolina, United States

Site Status

Sioux Falls VA Medical Center

Sioux Falls, South Dakota, United States

Site Status

Countries

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United States

References

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Coleman EA, Smith JD, Raha D, Min SJ. Posthospital medication discrepancies: prevalence and contributing factors. Arch Intern Med. 2005 Sep 12;165(16):1842-7. doi: 10.1001/archinte.165.16.1842.

Reference Type BACKGROUND
PMID: 16157827 (View on PubMed)

Cornish PL, Knowles SR, Marchesano R, Tam V, Shadowitz S, Juurlink DN, Etchells EE. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005 Feb 28;165(4):424-9. doi: 10.1001/archinte.165.4.424.

Reference Type BACKGROUND
PMID: 15738372 (View on PubMed)

Schnipper JL, Kirwin JL, Cotugno MC, Wahlstrom SA, Brown BA, Tarvin E, Kachalia A, Horng M, Roy CL, McKean SC, Bates DW. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006 Mar 13;166(5):565-71. doi: 10.1001/archinte.166.5.565.

Reference Type BACKGROUND
PMID: 16534045 (View on PubMed)

Institute for Healthcare Improvement. Medication Reconciliation Review. 2007; http://www.ihi.org/IHI/Topics/PatientSafety/MedicationSystems/Tools/Medication+Reconciliation+Review.htm. Accessed January 7, 2010.

Reference Type BACKGROUND

Tam VC, Knowles SR, Cornish PL, Fine N, Marchesano R, Etchells EE. Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. CMAJ. 2005 Aug 30;173(5):510-5. doi: 10.1503/cmaj.045311.

Reference Type BACKGROUND
PMID: 16129874 (View on PubMed)

Pippins JR, Gandhi TK, Hamann C, Ndumele CD, Labonville SA, Diedrichsen EK, Carty MG, Karson AS, Bhan I, Coley CM, Liang CL, Turchin A, McCarthy PC, Schnipper JL. Classifying and predicting errors of inpatient medication reconciliation. J Gen Intern Med. 2008 Sep;23(9):1414-22. doi: 10.1007/s11606-008-0687-9. Epub 2008 Jun 19.

Reference Type BACKGROUND
PMID: 18563493 (View on PubMed)

Vira T, Colquhoun M, Etchells E. Reconcilable differences: correcting medication errors at hospital admission and discharge. Qual Saf Health Care. 2006 Apr;15(2):122-6. doi: 10.1136/qshc.2005.015347.

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Wortman SB. Medication reconciliation in a community, nonteaching hospital. Am J Health Syst Pharm. 2008 Nov 1;65(21):2047-54. doi: 10.2146/ajhp080091.

Reference Type BACKGROUND
PMID: 18945865 (View on PubMed)

Schnipper JL, Hamann C, Ndumele CD, Liang CL, Carty MG, Karson AS, Bhan I, Coley CM, Poon E, Turchin A, Labonville SA, Diedrichsen EK, Lipsitz S, Broverman CA, McCarthy P, Gandhi TK. Effect of an electronic medication reconciliation application and process redesign on potential adverse drug events: a cluster-randomized trial. Arch Intern Med. 2009 Apr 27;169(8):771-80. doi: 10.1001/archinternmed.2009.51.

Reference Type BACKGROUND
PMID: 19398689 (View on PubMed)

Doyle E. Medication reconciliation done right. Today's Hospitalist. September 2009.

Reference Type BACKGROUND

Coffey M, Cornish P, Koonthanam T, Etchells E, Matlow A. Implementation of admission medication reconciliation at two academic health sciences centres: challenges and success factors. Healthc Q. 2009;12 Spec No Patient:102-9. doi: 10.12927/hcq.2009.20719.

Reference Type BACKGROUND
PMID: 19667786 (View on PubMed)

Brown C, Lilford R. Evaluating service delivery interventions to enhance patient safety. BMJ. 2008 Dec 17;337:a2764. doi: 10.1136/bmj.a2764. No abstract available.

Reference Type BACKGROUND
PMID: 19091764 (View on PubMed)

Schnipper JL, Roumie CL, Cawthon C, Businger A, Dalal AK, Mugalla I, Eden S, Jacobson TA, Rask KJ, Vaccarino V, Gandhi TK, Bates DW, Johnson DC, Labonville S, Gregory D, Kripalani S; PILL-CVD Study Group. Rationale and design of the Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) study. Circ Cardiovasc Qual Outcomes. 2010 Mar;3(2):212-9. doi: 10.1161/CIRCOUTCOMES.109.921833.

Reference Type BACKGROUND
PMID: 20233982 (View on PubMed)

Agency for Healthcare Research and Quality. CAHPS Hospital Survey (H-CAHPS) 2009; https://www.cahps.ahrq.gov/content/products/HOSP/PROD_HOSP_Intro.asp?p=1022&s=221. Accessed January 15, 2010.

Reference Type BACKGROUND

Parry C, Mahoney E, Chalmers SA, Coleman EA. Assessing the quality of transitional care: further applications of the care transitions measure. Med Care. 2008 Mar;46(3):317-22. doi: 10.1097/MLR.0b013e3181589bdc.

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Cochrane Collaboration. Effective Practice and Organization of Care (EPOC) Methods Paper: Including interrupted time series (ITS) designs in a EPOC review. 1998.

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Bazeley P. Computerized data analysis for mixed methods research. In: Tashakkori A, Teddlie C, eds. Mixed methodology: combining qualitative and quantitative approaches. Thousand Oaks, CA: Sage; 2003.

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Reference Type BACKGROUND
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Joint Commission on Accreditation of Healthcare Organizations. Joint Commission Fact Sheets: Facts about the tracer methodology. 2006; http://www.jointcommission.org/AboutUs/Fact_Sheets/Tracer_Methodology.htm. Accessed January 15, 2010.

Reference Type BACKGROUND

Agency for Healthcare Research and Quality. Hospital Survey on Patient Safety Culture. 2009; http://www.ahrq.gov/qual/patientsafetyculture/hospsurvindex.htm. Accessed January 10, 2010.

Reference Type BACKGROUND

Joint Commission on Accreditation of Healthcare Organizations. Accreditation Program: Hospital 2011 National Patient Safety Goals; http://www.jointcommission.org/assets/1/6/2011_NPSGs_HAP.pdf. Accessed April 12, 2011.

Reference Type BACKGROUND

Gillespie U, Alassaad A, Henrohn D, Garmo H, Hammarlund-Udenaes M, Toss H, Kettis-Lindblad A, Melhus H, Morlin C. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Arch Intern Med. 2009 May 11;169(9):894-900. doi: 10.1001/archinternmed.2009.71.

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Koehler BE, Richter KM, Youngblood L, Cohen BA, Prengler ID, Cheng D, Masica AL. Reduction of 30-day postdischarge hospital readmission or emergency department (ED) visit rates in high-risk elderly medical patients through delivery of a targeted care bundle. J Hosp Med. 2009 Apr;4(4):211-8. doi: 10.1002/jhm.427.

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Mixon AS, Kripalani S, Stein J, Wetterneck TB, Kaboli P, Mueller S, Burdick E, Nolido NV, Labonville S, Minahan JA, Orav EJ, Goldstein J, Schnipper JL. An On-Treatment Analysis of the MARQUIS Study: Interventions to Improve Inpatient Medication Reconciliation. J Hosp Med. 2019 Oct 1;14(10):614-617. doi: 10.12788/jhm.3308. Epub 2019 Aug 16.

Reference Type DERIVED
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Schnipper JL, Mixon A, Stein J, Wetterneck TB, Kaboli PJ, Mueller S, Labonville S, Minahan JA, Burdick E, Orav EJ, Goldstein J, Nolido NV, Kripalani S. Effects of a multifaceted medication reconciliation quality improvement intervention on patient safety: final results of the MARQUIS study. BMJ Qual Saf. 2018 Dec;27(12):954-964. doi: 10.1136/bmjqs-2018-008233. Epub 2018 Aug 20.

Reference Type DERIVED
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Salanitro AH, Kripalani S, Resnic J, Mueller SK, Wetterneck TB, Haynes KT, Stein J, Kaboli PJ, Labonville S, Etchells E, Cobaugh DJ, Hanson D, Greenwald JL, Williams MV, Schnipper JL. Rationale and design of the Multicenter Medication Reconciliation Quality Improvement Study (MARQUIS). BMC Health Serv Res. 2013 Jun 25;13:230. doi: 10.1186/1472-6963-13-230.

Reference Type DERIVED
PMID: 23800355 (View on PubMed)

Other Identifiers

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1R18HS019598

Identifier Type: AHRQ

Identifier Source: secondary_id

View Link

2010P001814

Identifier Type: -

Identifier Source: org_study_id

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