Virtual Continuity and Its Impact on Complex Hospitalized Patients' Care

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

835 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-08-31

Study Completion Date

2013-01-31

Brief Summary

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Communication between physicians caring for a patient in the hospital and that patient's primary care provider is less than optimal, and can lead to diminished health care quality and safety. This project will lead to better communication between physicians and could decrease medication errors that tend to occur as the patient goes from hospital to home.

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Detailed Description

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Communication between physicians caring for hospitalized patients and those patients' primary care providers (PCPs) is often suboptimal. Hospital-based information systems can improve communication by automating information exchange between hospital physicians and PCPs, and perhaps, as a result, improve the quality and safety of health care. MedTrak, the University of Pittsburgh Medical Center (UPMC) electronic physician communication tool, has proven successful and is poised to move forward with an initiative the investigators call virtual continuity, allowing PCPs to follow their patients electronically if they cannot do so physically. Virtual continuity will include: emails to PCPs triggered by clinical events with embedded links to electronic medical record data and communication portals, medication lists electronically delivered to PCPs at admission and discharge, and immediate PCP notification of discharge with pertinent clinical details. To evaluate virtual continuity, the investigators will examine the frequency of discharge medication errors in complex medical patients using a pre-post study design of virtual continuity compared to usual communication. Medication errors will be ascertained using accepted methods. The investigators will also investigate differences in rehospitalization, post discharge emergency department visit and PCP follow up rates. The IT cost of implementing and maintaining the virtual continuity intervention will also be assessed. Virtual continuity will allow PCPs to participate more directly in the care of their hospitalized patients. Improved communication could lead to higher-quality patient care and greater patient care safety for hospitalized patients with complex medical problems.

Conditions

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Automated Communication Tools Complex Medical Patients

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

SINGLE

Participants

Study Groups

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(Usual) MedTrak system of PCP notification

MedTrak, the information system used by the University of Pittsburgh Medical Center (UPMC), currently notifies PCPs when patients are admitted and discharged from the hospital.

Group Type NO_INTERVENTION

No interventions assigned to this group

Automated communication tools

An enhanced version of MedTrak (the present system of PCP notification). Electronic medical record links will be developed and used to allow automated communication with the PCP.

Group Type EXPERIMENTAL

Automated communication tools

Intervention Type OTHER

Automated communication tools will include:

* PCP notification of patient admission and location
* Data on medications begun on admission
* Automated alerts on changes in patient status and location while the patient is hospitalized
* Links to the EMR and to hospital physician contact information on all email alerts
* Real-time delivery of discharge information (medications, instructions, and follow-up) to the PCP
* Automatic reporting to PCPs of test results pending at discharge
* Electronic delivery of final discharge summaries

Interventions

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Automated communication tools

Automated communication tools will include:

* PCP notification of patient admission and location
* Data on medications begun on admission
* Automated alerts on changes in patient status and location while the patient is hospitalized
* Links to the EMR and to hospital physician contact information on all email alerts
* Real-time delivery of discharge information (medications, instructions, and follow-up) to the PCP
* Automatic reporting to PCPs of test results pending at discharge
* Electronic delivery of final discharge summaries

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Are admitted to UPMC Presbyterian General Medicine, Geriatrics, Cardiology, or Surgery inpatient services;
* Are 18 years of age or older;
* Are currently receiving 5 or more medications;
* Have 2 or more comorbid conditions present, defined using the Elixhauser comorbidity system (Med Care 1998;36:8-27 and Med Care. 2005 Nov; 43(11): 1130-9 ). These comorbidities are: congestive heart failure, cardiac arrhythmias, valvular disease, pulmonary circulation disorders, peripheral vascular disorders, hypertension, paralysis, other neurologic disorders, chronic pulmonary disease, diabetes uncomplicated, diabetes complicated, hypothyroidism, renal failure, liver disease, peptic ulcer disease excluding bleeding, AIDS/HIV disease, lymphoma, metastatic cancer, solid tumor without metastasis, rheumatoid arthritis/collagen vascular diseases, coagulopathy, obesity, weight loss, fluid and electrolyte disorders, blood loss anemia, deficiency anemias, alcohol abuse, drug abuse, psychoses, and depression
* Have a Primary Care Physician who has outpatient data included on EPIC electronic health record.

Exclusion Criteria

* Are admitted to critical care units;
* Are admitted from skilled nursing facilities;
* Have dementia;
* Were previously enrolled in the study
* Are organ transplant recipients

Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No