Virtual Continuity and Its Impact on Complex Hospitalized Patients' Care
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.
Complex Medical Patients
Other: Virtual Continuity
|Study Design:||Allocation: Non-Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Subject)
Primary Purpose: Health Services Research
|Official Title:||Virtual Continuity and Its Impact on Complex Hospitalized Patients' Care|
- Medication errors at hospital discharge [ Time Frame: Approximately 1-30 days ] [ Designated as safety issue: No ]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.
- Patient PCP visits, emergency room visits and rehospitalizations within 30 days post-discharge. [ Time Frame: Within 30 post-discharge from hospital ] [ Designated as safety issue: No ]Details regarding patient PCP follow-up office appointments, ER visits and rehospitalizations occuring within 30 days post-discharge will be collected from the EMR.
|Study Start Date:||August 2010|
|Study Completion Date:||January 2013|
|Primary Completion Date:||January 2013 (Final data collection date for primary outcome measure)|
No Intervention: (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.
Experimental: Virtual Continuity
An enhanced version of MedTrak (the present system of PCP notification). Electronic medical record links will be developed and used to allow virtual continuity for the PCP.
Other: Virtual Continuity
Virtual continuity will include:
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.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01397253
|United States, Pennsylvania|
|UPMC Presbyterian Hospital|
|Pittsburgh, Pennsylvania, United States, 15213-2582|
|Principal Investigator:||Kenneth J Smith, MD, MS||University of Pittsburgh Medical Center, University of Pittsburgh|