Virtual Continuity and Its Impact on Complex Hospitalized Patients' Care

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01397253
Recruitment Status : Completed
First Posted : July 19, 2011
Results First Posted : March 25, 2015
Last Update Posted : April 16, 2015
Agency for Healthcare Research and Quality (AHRQ)
Information provided by (Responsible Party):
University of Pittsburgh

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.

Condition or disease Intervention/treatment Phase
Automated Communication Tools Complex Medical Patients Other: Automated communication tools Phase 3

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.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 835 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Primary Purpose: Health Services Research
Official Title: Virtual Continuity and Its Impact on Complex Hospitalized Patients' Care
Study Start Date : August 2010
Actual Primary Completion Date : January 2013
Actual Study Completion Date : January 2013

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
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: Automated communication tools
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

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

Primary Outcome Measures :
  1. Medication Errors at Hospital Discharge [ Time Frame: Approximately 1-30 days ]
    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 :
  1. Patient PCP Visits, Emergency Room Visits and Rehospitalizations Within 30 Days Post-discharge. [ Time Frame: Within 30 post-discharge from hospital ]
    Details regarding patient PCP follow-up office appointments, ER visits and rehospitalizations occuring within 30 days post-discharge will be collected from the EMR.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

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

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01397253

United States, Pennsylvania
UPMC Presbyterian Hospital
Pittsburgh, Pennsylvania, United States, 15213-2582
Sponsors and Collaborators
University of Pittsburgh
Agency for Healthcare Research and Quality (AHRQ)
Principal Investigator: Kenneth J Smith, MD, MS University of Pittsburgh Medical Center, University of Pittsburgh

Responsible Party: University of Pittsburgh Identifier: NCT01397253     History of Changes
Other Study ID Numbers: 3130920
First Posted: July 19, 2011    Key Record Dates
Results First Posted: March 25, 2015
Last Update Posted: April 16, 2015
Last Verified: March 2015

Keywords provided by University of Pittsburgh:
Automated Communication Tools
Medication errors
PCP communication