Value of Technology to Transfer Discharge Information

NCT00101868 | Completed Results

• 2 other identifiers: 1R01HS015084-011R01HS015084-02
• Study Type: interventional
• Target: 631
• Locations: 1 country
• Sites: 1

Brief Summary

The transition from hospital to home is a high-risk period in a patient's illness. Poor communication between healthcare providers at hospital discharge is common and contributes to adverse events affecting patients after discharge. The importance of good communication at discharge will increase as more primary care providers delegate inpatient care to hospitalists. Any process that improves information transfer among providers at discharge might improve the health and safety of patients discharged from U.S. hospitals each year, and to appreciably reduce unnecessary healthcare expenditures. Information transfer among healthcare providers and their patients can be undermined because of inaccuracies, omissions, illegibility, logistical failure (e.g., information is never delivered), and delays in generation (i.e., dictation or transcription) or transmission. Root causes include recall error, increased physician workloads, interface failures (e.g., physician-clerical) and poor training of physicians in the discharge process. Many of the deficiencies in the current process of information transfer at hospital discharge could be effectively addressed by the application of information technology. The proposed study will measure the value of a software application to facilitate information transfer at hospital discharge. The study is designed to compare the benefits of discharge health information technology versus usual care in high-risk patients recently discharged from acute care hospitalization. The design is a randomized, single-blind, controlled trial. The outcomes are readmission within 6 months, adverse events, and effectiveness and satisfaction with the discharge process from the patient and physician perspectives. The cost outcome is the physician time required to use the discharge software.

Conditions

Information Dissemination; Interprofessional Relations

Keywords

Aged; Hospitalists; Outcome and process assessment (health care); Human; Hospitals, teaching; Physicians, family; Medical records; Quality assurance, health care; Medical errors

Outcome Measures

Primary Outcomes (1)

• Hospital Readmission, at Least One

  Number of participants with at least one readmission within 6 months after discharge from index hospital visit

  within 6 months after discharge

Secondary Outcomes (12)

• Patients' Perception of Discharge Process, Effectiveness, Satisfaction, Preparedness

  1 week after discharge

• Patients' Perception of Discharge Process, Satisfaction

  1 week after discharge

• Pharmacist Needed to Clarify the Discharge Prescription

  1 day after discharge

• Pharmacist's Satisfaction With Discharge Prescription

  1 day after discharge

• At Least One Adverse Event Within One Month After Discharge

  1 month after discharge

Study Arms (2)

Discharge communication software

EXPERIMENTAL

Computerized-Physician-Order-Entry software application to facilitate communication at time of hospital discharge to patients, retail pharmacists, community physicians. Software had required fields, pick lists, standard drug doses, alerts, reminders, online reference information. Software prompted discharging physician to enter pending tests, order tests after discharge. Hospital physicians used software on day of discharge to generate four documents automatically: personalized letter to outpatient physician, legible prescriptions, and legible discharge order

Device: Discharge communication software

Usual care discharge process

ACTIVE COMPARATOR

Hospital physicians and ward nurses completed handwritten discharge forms on the day of discharge. The forms contained blanks for discharge diagnoses, discharge medications, medication instructions, post discharge activities and restrictions, post discharge diet, post discharge diagnostic and therapeutic interventions, and appointments. Patients received handwritten copies of the forms, one page of which also included medication instructions and prescriptions

Other: Usual care discharge process

Interventions

Discharge communication software DEVICE

Computerized physician order entry software used by discharging physician

Also known as: Discharge assistant, Hospital Information Systems, Medical Records Systems-Computerized, Electronic Discharge Summary, Medication Reconciliation

Discharge communication software

Usual care discharge process OTHER

Handwritten

Also known as: Usual care, handwritten

Usual care discharge process

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Inpatients at OSF Saint Francis Medical Center
• Discharged by the hospitalist service or other inpatient services
• High risk for poor post-discharge outcomes defined as probability of readmission (PRA) 0.4 or above

You may not qualify if:

• Less than 18 years old
• Unwilling or unable to provide written consent
• Life expectancy less than 6 months
• Will receive outpatient care from a primary care physician who is the same as the discharging physician
• Do not speak English or Spanish
• Not alert and oriented when admitted
• Do not have telephone for post-discharge contact
• Do not reside in Central Illinois
• Will be discharged to a nursing home
• Previously enrolled as subjects in the trial

Sponsors & Collaborators

• Agency for Healthcare Research and Quality (AHRQ): lead
• University of Illinois at Chicago: collaborator

Study Sites (1)

OSF Saint Francis Medical Center

Peoria, Illinois, 61637, United States

Location

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MeSH Terms

Interventions

Medical Records Systems, Computerized; Medication Reconciliation

Intervention Hierarchy (Ancestors)

Medical Records; Records; Data Collection; Epidemiologic Methods; Investigative Techniques; Organization and Administration; Health Services Administration; Health Care Evaluation Mechanisms; Quality of Health Care; Health Care Quality, Access, and Evaluation; Public Health; Environment and Public Health; Medication Errors; Drug Therapy; Therapeutics; Medical Errors; Health Services; Health Care Facilities Workforce and Services; Medication Systems; Patient Care Management

Limitations and Caveats

Required medication reconciliation in both groups might have reduced the adverse event rates in both groups.

Results Point of Contact

• Title: James F. Graumlich, MD, Professor of Medicine
• Organization: University of Illinois

jfg@uic.edu

309-655-7734

Study Officials

• James F Graumlich, MD

  University of Illinois College of Medicine

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: FED
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor of Medicine

Study Record Dates

• First Submitted: January 14, 2005
• First Posted: January 17, 2005
• Study Start: December 1, 2004
• Primary Completion: August 1, 2007
• Study Completion: August 1, 2007
• Last Updated: May 15, 2012
• Results First Posted: May 15, 2012

Record last verified: 2012-04

Locations

US (1)