Virtual Continuity and Its Impact on Complex Hospitalized Patients' Care

This study has been completed.
Sponsor:
Collaborator:
Information provided by (Responsible Party):
University of Pittsburgh
ClinicalTrials.gov Identifier:
NCT01397253
First received: July 15, 2011
Last updated: January 29, 2013
Last verified: January 2013
  Purpose

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.


Condition Intervention Phase
Virtual Continuity
Complex Medical Patients
Other: Virtual Continuity
Phase 3

Study Type: Interventional
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

Resource links provided by NLM:


Further study details as provided by University of Pittsburgh:

Primary Outcome Measures:
  • 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.


Secondary Outcome Measures:
  • 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.


Enrollment: 840
Study Start Date: August 2010
Study Completion Date: January 2013
Primary Completion Date: January 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
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:

  • 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

Detailed Description:

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.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • 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.

Exclusion Criteria:

  • Are admitted to critical care units;
  • Are admitted from skilled nursing facilities;
  • Have dementia;
  • Were previously enrolled in the study
  • Are organ transplant recipients
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01397253

Locations
United States, Pennsylvania
UPMC Presbyterian Hospital
Pittsburgh, Pennsylvania, United States, 15213-2582
Sponsors and Collaborators
University of Pittsburgh
Investigators
Principal Investigator: Kenneth J Smith, MD, MS University of Pittsburgh Medical Center, University of Pittsburgh
  More Information

Publications:
Responsible Party: University of Pittsburgh
ClinicalTrials.gov Identifier: NCT01397253     History of Changes
Other Study ID Numbers: 3130920
Study First Received: July 15, 2011
Last Updated: January 29, 2013
Health Authority: United States: Institutional Review Board

Keywords provided by University of Pittsburgh:
Virtual Continuity
Medication errors
PCP communication

ClinicalTrials.gov processed this record on October 23, 2014