Minimizing Errors in Medication Histories Obtained at Hospital Admission

最大限度地减少入院时获得的用药史的错误

基本信息

批准号：
9232962
负责人：
Joshua M Pevnick
金额：
$ 20.21万
依托单位：
CEDARS-SINAI MEDICAL CENTER
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：
2015-08-01 至 2019-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9232962
关键词：
Accident and Emergency department Address Admission activity Adverse drug event Affect Aging Appointment Biometry Caregivers Caring Cessation of life Chiroptera Clinical Clinical Trials Design Complex Data Discipline of Nursing Doctor of Pharmacy Doctor of Philosophy Elderly Electronic Health Record Equilibrium Exclusion Foundations Funding Geriatrics Goals Government Health Services Health Services Research Health system Healthcare Healthcare Systems Home environment Hospitals Human Resources Incentives Informatics Information Technology Injury Internist Intervention Intervention Studies Lead Learning Measures Medical Medical Informatics Medical Records Medication Errors Medication Management Medicine Mentors Methodology Methods Morbidity - disease rate Nurses Older Population Patients Pharmaceutical Preparations Pharmacists Pharmacologic Substance Pharmacy facility Phonation Physicians Physiological Process Provider Public Health Randomized Controlled Trials Recording of previous events Records Regimen Research Research Personnel Research Project Grants Research Proposals Retrospective Studies Science Suggestion Supervision Telephone Testing Time Training Training Support Work base career career development cost cost effective cost efficient design electronic data improved meetings mortality older patient prevent professor public health relevance therapy design trial design ward

项目摘要

DESCRIPTION (provided by applicant): Joshua Pevnick, MD, MSHS is a general internist with Assistant Professor appointments at Cedars-Sinai Health System (CSHS) and UCLA. He practices hospital medicine and has been conducting health services research (HSR) focusing on information technology interventions to improve medication management. Recently, he has seen that those likely to benefit most from his work are older adults, as they have the most complex medication regimens, the least ability to remember these regimens, and the least physiologic reserve to tolerate adverse drug events. Furthermore, almost all of his clinical work and research is conducted at CSHS, which is known to have a disproportionately older population. Finally, this issue is best addressed in a patient-centric, rather than solution-centri, manner. For all of these reasons, further geriatric training would substantially benefit his research. He has thus recently changed his career goal to: Become a leading health services researcher advancing the study of medication management in seniors at care transitions. To achieve this goal, Dr. Pevnick proposes a mentoring plan involving regular meetings with four mentors: Douglas Bell, MD, PhD (content expertise in informatics, methodological expertise in HSR), Catherine Sarkisian, MD, MSPH (content expertise in geriatrics, methodological expertise in HSR), Cynthia Jackevicius, PharmD (content expertise in pharmaceutical sciences, methodological expertise in HSR), and Andre Rogatko, PhD (methodological expertise in biostatistics and trial design). His career development will also be supported by training plans emphasizing geriatrics, clinical trial design, grantwriting and medical informatics. Finally, he wil conduct a research project to generate results important for their own sake, to serve as a vehicle to apply what he learns from mentors and classes, and to build a foundation for future research proposals. Dr. Pevnick proposes to study three interventions to improve the accuracy of medication histories obtained at hospital admission. The interventions will target older adult patients prone to erroneous medication histories and concomitant medication errors. For predominantly older patients on complex home medication regimens, Dr. Pevnick is conducting a randomized controlled trial (RCT) to test the effect of using pharmacists and pharmacy technicians to obtain an initial admission medication history (AMH) on its accuracy. He will retrospectively study the potential benefit of accessing electronic medication fill data at the tim of admission to improve AMH accuracy. After analyzing both how these interventions affect AMH accuracy and the labor costs for these interventions, Dr. Pevnick will lead the design and refinement of a combined intervention targeted at seniors, which will ultimately be tested in a second RCT. Improving AMH accuracy is accepted as a necessary first step in preventing adverse drug events, which cause over 100,000 deaths in hospitalized US patients annually. Beyond studying potential solutions to this public health threat, this research project will provid Dr. Pevnick the opportunity to develop himself into a leading independent investigator in aging science.

描述（由申请人提供）：MSHS医学博士Joshua Pevnick是一名普通内科医生，在Cedars-Sinai Health System（CSHS）和UCLA的助理教授任命。他从事医院医学，并一直在进行医疗服务研究（HSR），重点是信息技术干预措施以改善药物管理。最近，他看到那些可能从他的工作中受益最大的人是老年人，因为他们拥有最复杂的药物治疗方案，记住这些方案的最低能力以及可忍受不良药物事件的生理储备最少。此外，他几乎所有的临床工作和研究都在CSHS进行，众所周知，这是老年人群不成比例的。最后，以患者为中心而不是解决方案中心的方式，最好解决此问题。由于所有这些原因，进一步的老年培训将显着有益于他的研究。因此，他最近将自己的职业目标改变为：成为一名领先的卫生服务研究人员，推进了护理过渡中老年人的药物管理研究。为了实现这一目标，佩夫尼克博士提出了一项指导计划，涉及与四位导师的定期会议：道格拉斯·贝尔（Douglas Bell），医学博士，博士学位（信息学方面的内容专业知识，HSR的方法论专业知识），凯瑟琳·萨基斯（Catherine Sarkisian） HSR的专业知识），Cynthia Jackevicius，PharmD（药学的内容专业知识，HSR的方法论专业知识）和Andre Rogatko，博士学位（生物统计学和试验设计的方法论专业知识）。强调老年医学，临床试验设计，授予写作和医学信息学的培训计划也将支持他的职业发展。最后，他将进行一项研究项目，以创造出对自己的缘故重要的结果，以作为应用他从导师和课程中学到的知识，并为未来的研究建议建立基础的工具。 Pevnick博士建议研究三种干预措施，以提高住院时获得的药物历史的准确性。这些干预措施将针对老年人患者，容易出现错误的药物病史和随之而来的药物错误。对于主要是复杂家庭药物治疗方案的老年患者，Pevnick博士正在进行一项随机对照试验（RCT），以测试使用药剂师和药房技术人员获得初始入院药物病史（AMH）对其准确性的影响。他将回顾性地研究在接纳时访问电子药物填充数据以提高AMH准确性的潜在优势。在分析了这些干预措施如何影响AMH的准确性和这些干预措施的人工成本之后，Pevnick博士将领导针对老年人的合并干预措施的设计和完善，最终将在第二个RCT中进行测试。提高AMH准确性被认为是预防不良毒品事件的必要第一步，每年住院的美国患者死亡超过100,000人死亡。除了研究这种公共卫生威胁的潜在解决方案外，该研究项目还将为佩夫尼克博士提供发展自己成为老龄化科学领域的独立研究者的机会。