Virtual Continuity and Its Impact on Complex Hospitalized Patients' Care

NCT01397253 | Completed Phase 3 Results

• 1 other identifier: 3130920
• Study Type: interventional
• Target: 835
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Automated Communication Tools; Complex Medical Patients

Keywords

Automated Communication Tools; Medication errors; PCP communication

Outcome Measures

Primary Outcomes (1)

• Medication Errors at Hospital Discharge

  Medication name, dose, and frequency of administration for patient pre-admission medications will be recorded. Medications received during the hospitalization and discharge medications will be obtained by medical record review following hospital discharge. Pre-admission medications will be compared to discharge medications and differences will be considered discharge medication variances. Two trained pharmacists will independently review medication variances to determine clinical indications or medication errors.

  Approximately 1-30 days

Secondary Outcomes (1)

• Patient PCP Visits, Emergency Room Visits and Rehospitalizations Within 30 Days Post-discharge.

  Within 30 post-discharge from hospital

Study Arms (2)

(Usual) MedTrak system of PCP notification

NO INTERVENTION

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.

Automated communication tools

EXPERIMENTAL

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.

Other: Automated communication tools

Interventions

Automated communication tools 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

Automated communication tools

Eligibility Criteria

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

You may qualify if:

• 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.

You may not qualify if:

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

Sponsors & Collaborators

• University of Pittsburgh: lead
• Agency for Healthcare Research and Quality (AHRQ): collaborator

Study Sites (1)

UPMC Presbyterian Hospital

Pittsburgh, Pennsylvania, 15213-2582, United States

Location

Related Publications (5)

• Halasyamani L, Kripalani S, Coleman E, Schnipper J, van Walraven C, Nagamine J, Torcson P, Bookwalter T, Budnitz T, Manning D. Transition of care for hospitalized elderly patients--development of a discharge checklist for hospitalists. J Hosp Med. 2006 Nov;1(6):354-60. doi: 10.1002/jhm.129.

  PMID: 17219528 BACKGROUND

• Kripalani S, Jackson AT, Schnipper JL, Coleman EA. Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists. J Hosp Med. 2007 Sep;2(5):314-23. doi: 10.1002/jhm.228.

  PMID: 17935242 BACKGROUND

• Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007 Feb 28;297(8):831-41. doi: 10.1001/jama.297.8.831.

  PMID: 17327525 BACKGROUND

• Coleman EA, Boult C; American Geriatrics Society Health Care Systems Committee. Improving the quality of transitional care for persons with complex care needs. J Am Geriatr Soc. 2003 Apr;51(4):556-7. doi: 10.1046/j.1532-5415.2003.51186.x. No abstract available.

  PMID: 12657079 BACKGROUND

• Coleman EA, Mahoney E, Parry C. Assessing the quality of preparation for posthospital care from the patient's perspective: the care transitions measure. Med Care. 2005 Mar;43(3):246-55. doi: 10.1097/00005650-200503000-00007.

  PMID: 15725981 BACKGROUND

Results Point of Contact

• Title: Kenneth J Smith, MD, MS
• Organization: University of Pittsburgh

smithkj2@upmc.edu

4126474794

Study Officials

• Kenneth J Smith, MD, MS

  University of Pittsburgh Medical Center, University of Pittsburgh

  PRINCIPAL INVESTIGATOR

Publication Agreements

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

Study Design

• Study Type: interventional
• Phase: phase 3
• Allocation: NON RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 15, 2011
• First Posted: July 19, 2011
• Study Start: August 1, 2010
• Primary Completion: January 1, 2013
• Study Completion: January 1, 2013
• Last Updated: April 16, 2015
• Results First Posted: March 25, 2015

Record last verified: 2015-03

Locations

US (1)