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Virtual Continuity and Its Impact on Complex Hospitalized Patients' Care

This study has been completed.
Sponsor:
ClinicalTrials.gov Identifier:
NCT01397253
First Posted: July 19, 2011
Last Update Posted: April 16, 2015
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.
Collaborator:
Agency for Healthcare Research and Quality (AHRQ)
Information provided by (Responsible Party):
University of Pittsburgh
July 15, 2011
July 19, 2011
March 12, 2015
March 25, 2015
April 16, 2015
August 2010
January 2013   (Final data collection date for primary outcome measure)
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.
Medication Errors at Hospital Discharge [ Time Frame: Approximately 1 day to 2 months ]
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.
Complete list of historical versions of study NCT01397253 on ClinicalTrials.gov Archive Site
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.
PCP and patient satisfaction [ Time Frame: Approximately 30-45 days post-discharge from hospital ]
PCP satisfaction with communication and information received from hospital physicians (hospitalists) will be assessed using a modified Pantilat questionnaire after patient discharge. Details regarding patient follow-up office appointments, ER visits and rehospitalizations will be collected. Patient satisfaction will be measured using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospital Survey and the Care Transitions Measure (CTM) via telephone interview approximately 30-45 days post hospital discharge.
Not Provided
Not Provided
 
Virtual Continuity and Its Impact on Complex Hospitalized Patients' Care
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.
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.
Interventional
Phase 3
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Primary Purpose: Health Services Research
  • Automated Communication Tools
  • Complex Medical Patients
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
  • 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.
    Intervention: Other: Automated communication tools

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
835
January 2013
January 2013   (Final data collection date for primary outcome measure)

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
Sexes Eligible for Study: All
18 Years and older   (Adult, Senior)
No
Contact information is only displayed when the study is recruiting subjects
United States
 
 
NCT01397253
3130920
No
Not Provided
Not Provided
University of Pittsburgh
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
University of Pittsburgh
March 2015

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP