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Using Health Information Technology (HIT) to Improve Transitions of Complex Elderly Patients From Skilled Nursing Facility (SNF) to Home (RAMPAGEII)

This study has been completed.
Information provided by (Responsible Party):
Terry Field, University of Massachusetts, Worcester Identifier:
First received: July 22, 2009
Last updated: April 23, 2014
Last verified: April 2014
The incidence of drug-induced injury is high in the ambulatory geriatric population, especially for elders with complex healthcare needs during high risk transitions to the ambulatory setting. In a previous study funded by the National Institute on Aging and the Agency for Healthcare Research and Quality [AHRQ] (AG 15979), the investigators determined that drug-related injuries occur at a rate of more than 50 per 1000-patient years in older adults in the ambulatory setting and that 28% are preventable. Independent risk factors for adverse drug events among older adults in the ambulatory setting included advanced age, multiple comorbid conditions, and the use of medications requiring close monitoring. In this project, Using HIT to Improve Transitions of Complex Elderly Patients from SNF to Home (1 R18 HS017817), the investigators are testing the use of an electronic medical record (EMR)-based transitional care intervention for complex elderly patients transitioning from subacute care in a skilled nursing facility (SNF) to the ambulatory setting. The growing trend for physicians and other healthcare providers to restrict their practices to single settings and not follow complex patients as they move between settings leaves older patients discharged from subacute care particularly vulnerable. This transition is uniquely challenging because of the complex healthcare needs of this population, who often require outpatient primary care physicians to coordinate with visiting nurses in order to manage complex medication regimens and fluctuating clinical status. To facilitate high-quality transitions from the subacute to the ambulatory setting and support interdisciplinary communication, the investigators will use the EMR to assure that physicians in the ambulatory setting receive key health information and alerts.

Condition Intervention
Adverse Outcomes
Other: Intervention 1: Electronic medical record (EMR)-based transitional care intervention

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Health Services Research
Official Title: Using HIT to Improve Transitions of Complex Elderly Patients From SNF to Home

Further study details as provided by University of Massachusetts, Worcester:

Primary Outcome Measures:
  • Rate of follow-up to an outpatient provider within 21 days of SNF discharge. [ Time Frame: 1 year 3 months ]
  • Prevalence of appropriate monitoring for selected high risk medications at 30 days from the time of SNF discharge. [ Time Frame: 1 year 3 months ]
  • Incidence of adverse drug events (ADEs) 45 days after discharge. [ Time Frame: 1 year 3 months ]
  • Rate of SNF readmission and emergency department (ED) within 30 days of discharge. [ Time Frame: 1 year 3 months ]

Secondary Outcome Measures:
  • Determine costs directly related to the development and installation of the HIT-based transitional care intervention [ Time Frame: 3 years ]

Enrollment: 626
Study Start Date: April 2011
Study Completion Date: January 2013
Primary Completion Date: June 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Intervention Group 1
All participants
Other: Intervention 1: Electronic medical record (EMR)-based transitional care intervention
Electronic delivery of enhanced discharge information to the ambulatory physician with plans for follow-up appointment, notice of any new medications, and recommendations for laboratory monitoring


Ages Eligible for Study:   65 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

  • 65 years and older,
  • Member of the study site health plan,
  • Received care from one of the study site's geriatricians during a SNF stay,
  • Discharged from SNF to home.

Exclusion Criteria:

  • Does not meet inclusion criteria.
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Please refer to this study by its identifier: NCT01004328

United States, Massachusetts
Fallon Clinic
Worcester, Massachusetts, United States, 01605
Sponsors and Collaborators
University of Massachusetts, Worcester
Principal Investigator: Terry S Field, DSc University of Massachusetts Medical School/Meyers Primary Care Institute
  More Information

Responsible Party: Terry Field, Associate Professor, Meyers Primary Care Institute/University of Massachusetts Medical School., University of Massachusetts, Worcester Identifier: NCT01004328     History of Changes
Other Study ID Numbers: 1R18HS017817 ( US NIH Grant/Contract Award Number )
Study First Received: July 22, 2009
Last Updated: April 23, 2014

Keywords provided by University of Massachusetts, Worcester:
patient safety
care transitions
therapeutic monitoring
skilled nursing facilities
Adverse outcomes after discharge from a SNF to home processed this record on May 22, 2017