The Secure Messaging for Medication Reconciliation Tool (SMMRT) Trial

药物协调工具安全消息传递 (SMMRT) 试用

基本信息

批准号：
9145515
负责人：
STEVEN R. SIMON
金额：
--
依托单位：
VA BOSTON HEALTH CARE SYSTEM
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-07-01 至 2019-09-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9145515
关键词：
Address Address Admission activity Adverse drug event Adverse drug event Adverse event Adverse event Area Area Caring Caring Cessation of life Cessation of life Client satisfaction Client satisfaction Clinical Collaborations Collaborations Communication Communication Communities Communities Effectiveness Effectiveness Electronic Mail Electronic Mail Elements Elements Emergency department visit Emergency department visit Enrollment Enrollment Ensure Ensure Future Future Goals Goals Health Health Healthcare Healthcare Home environment Home environment Hospitalization Hospitalization Hospitals Hospitals Informatics Informatics Information Technology Information Technology Inpatients Inpatients Internet Internet Intervention Intervention Interview Interview Joints Joints Lead Lead Length of Stay Measures Measures Mediating Mediating Medical Records Medical Records Modeling Modeling Nurses Nurses Outcome Measure Outcome Measure Outpatients Outpatients Patient Discharge Patients Patients Pharmaceutical Preparations Pharmaceutical Preparations Pharmacists Pharmacists Pilot Projects Pilot Projects Primary Health Care Primary Health Care Primary Nursing Care Primary Nursing Care Qualitative Methods Qualitative Methods Randomized Randomized Randomized Controlled Trials Randomized Controlled Trials Reporting Reporting Research Research Research Personnel Research Personnel Secure Secure Self Efficacy Self Efficacy Testing Testing Training Training Veterans Veterans Visit Visit arm arm base base clinical practice clinical practice experience experience formative assessment formative assessment graphical user interface graphical user interface health administration health administration high risk high risk hospital readmission hospital readmission hospital utilization hospital utilization improved improved improved outcome improved outcome medication administration novel novel patient engagement patient portal pharmacy benefit pharmacy benefit prevent prevent primary outcome primary outcome programs programs satisfaction secondary outcome secondary outcome tool tool treatment as usual treatment as usual usability usability

项目摘要

DESCRIPTION (provided by applicant): Medication discrepancies, defined as unintentional differences found between patients' medical records and patients' reports of the medication they are taking, occur frequently after hospital discharge, predisposing to adverse drug events (ADEs), emergency department visits and readmissions. Resolving medication discrepancies - medication reconciliation - is mandated at every care transition, but little is known about intervention strategies to improve medication reconciliation in the post-discharge period, when patients may lack prompt access to primary care and are at high risk for ADEs. To address this gap, we developed and pilot tested the Secure Messaging for Medication Reconciliation Tool (SMMRT), with a pharmacist communicating with Veterans to review medications and reconcile discrepancies after hospital discharge via Secure Messaging (SM), within My HealtheVet (MHV), VA's patient portal. Our pilot study detected, on average, two clinically important medication discrepancies per Veteran immediately following discharge and demonstrated that Veterans could interact with the pharmacist asynchronously to resolve discrepancies. Veterans found SMMRT easy to use and indicated they would willingly use it again. We therefore propose the SMMRT Trial, in which we will optimize the end-users' experience with SMMRT, conduct a randomized controlled trial (RCT) of MHV training and SMMRT to reduce hospital utilization, and evaluate SMMRT for potential future implementation. For Aim 1, we will conduct formal usability assessment of SMMRT among Veterans (N=10) pharmacists (N=10) and nurses (N=10), refining the user interface for optimal acceptability and effectiveness. For Aim 2, we will mount a 3-arm RCT to evaluate the effects of MHV training and SMMRT, randomizing 1,400 hospitalized Veterans to compare 1) Usual Care (UC), 2) UC + MHV enrollment and training (i.e., "MHV training"), and 3) UC + MHV training + SMMRT after discharge. The primary outcome measure will be 30-day hospital utilization (combined readmissions plus emergency department visits) with the primary hypothesis that SMMRT will reduce hospital utilization compared with UC. For Aim 3, we will carry out a formative evaluation of the interventions for potential future implementation, with qualitative analysis of in-depth interviews from among 20 Veterans and 10-15 primary care nurses. We will collaborate with operational partners: the Veterans' Consumer Health Information Office, which oversees MHV program activities, and the National Medication Reconciliation Initiative, within Pharmacy Benefits Management, responsible for implementing the VA Directive regarding medication reconciliation. If proven effective, SMMRT will have several impacts on Veterans and their health care: 1) decreased medication discrepancies; 2) decreased emergency room visits and hospital readmissions following discharge, which are commonly the result of ADE; 3) improved measures of patient- engagement, patient-centeredness, and patient satisfaction. This study directly supports VA's Transformational Initiative to employ state-of-the-art information technology in the delivery of Veterans' health care.

描述（由申请人提供）：药物差异被定义为患者的病历和患者对他们所服用的药物的报告之间的无意差异，经常发生在住院后，易于接受药物（ADE），急诊就诊和再选中。解决药物差异 - 药物对帐 - 在每个护理过渡时都要授权，但是当患者可能无法迅速获得初级保健且处于ADE的高风险时，对改善药物和解的干预策略知之甚少。为了解决这一差距，我们开发并试点测试了药物对帐工具（SMMRT）的安全消息传递，并通过药剂师与退伍军人进行沟通，以审查药物，并在我的HealthVet（MHV）内通过安全消息（SM）在医院出院后进行调和差异，VA的患者门户网站。我们的试点研究平均在出院后立即检测到每位退伍军人的两种临床上重要的药物差异，并证明退伍军人可以异步与药剂师互动以解决差异。退伍军人发现SMMRT易于使用，并表示他们会再次使用它。因此，我们提出了SMMRT试验，其中我们将优化最终用户在SMMRT方面的经验，对MHV培训和SMMRT进行随机对照试验（RCT），以减少医院利用，并评估SMMRT的潜在未来实施。对于AIM 1，我们将对退伍军人（n = 10）（n = 10）和护士（n = 10）的SMMRT进行正式可用性评估，以完善用户界面以获得最佳的可接受性和有效性。对于AIM 2，我们将安装3臂RCT来评估MHV培训和SMMRT的效果，将1,400名住院的退伍军人随机化以比较1）常规护理（UC），2）UC + MHV注册和培训（即“ MHV培训”），以及3），以及3）UC + MHV培训 + SMMRT后。主要结局措施将是30天的医院利用率（联合再入院以及急诊就诊），其主要假设是SMMRT将减少与UC相比的医院利用率。对于AIM 3，我们将对潜在的未来实施的干预措施进行形成性评估，并对20名退伍军人和10-15名初级保健护士的深入访谈进行定性分析。我们将与运营合作伙伴合作：在药房福利管理中监督MHV计划活动的退伍军人消费者健康信息办公室以及国家药物和解计划，负责实施有关药物对帐的VA指令。如果被证明有效，SMMRT将对退伍军人及其医疗保健产生一些影响：1）改善药物差异； 2）改善出院后急诊室就诊和医院再入院，这通常是ADE的结果； 3）改善了患者参与，以患者为中心和患者满意度的度量。这项研究直接支持VA向员工提供退伍军人医疗保健方面的最先进信息技术的变革计划。