Ambulatory Medication Reconciliation Following Hospital Discharge

The recruitment status of this study is unknown because the information has not been verified recently.
Verified January 2011 by Brigham and Women's Hospital.
Recruitment status was  Active, not recruiting
Sponsor:
Information provided by:
Brigham and Women's Hospital
ClinicalTrials.gov Identifier:
NCT00740675
First received: December 28, 2007
Last updated: January 5, 2011
Last verified: January 2011
  Purpose

Adverse drug events (ADEs) after hospital discharge are common. The purpose of this research study is see if we can design an electronic tool given to your primary care provider (PCP) that will reduce adverse drug events, hospital readmissions, and emergency department visits after you are discharged from the hospital.


Condition Intervention
Medication Administered in Error
Adverse Drug Events
Other: Outpatient Medication Reconciliation

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Outcomes Assessor)
Primary Purpose: Health Services Research
Official Title: Ambulatory Medication Reconciliation Following Hospital Discharge: Project 4 From "Center for Education and Research on Therapeutics (CERT) on Health Information Technology"

Further study details as provided by Brigham and Women's Hospital:

Primary Outcome Measures:
  • presence of at least one serious medication error per patient [ Time Frame: 30 days post-discharge ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • ED visits and non-scheduled hospital readmissions and ED visits [ Time Frame: within 30 days of discharge ] [ Designated as safety issue: No ]
  • Accuracy of medication list in ambulatory electronic medical record [ Time Frame: 30 days post discharge ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 912
Study Start Date: April 2008
Estimated Study Completion Date: February 2011
Primary Completion Date: August 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1

At post-discharge follow-up visit with PCP, PCP views:

  1. Discharge medication reconciliation screen.
  2. Prompts to perform post-discharge reconciliation at the first post-discharge visit.
Other: Outpatient Medication Reconciliation

The post-discharge medication reconciliation module has the following features:

  1. Presents the (preadmission) ambulatory medication list and the hospital discharge medication list side-by-side, sorted by class, with all identical medications lined up next to each other and all differences in the two regimens highlighted.
  2. Allows users to update the ambulatory medication list with a few keystrokes (i.e., to accept individual changes made during the hospitalization).
  3. Allows reconciliation to be performed in full (e.g., for PCPs who are responsible for the entire medication list) or in part (e.g., for specialists).
No Intervention: Uusual care
PCPs manage the patient's medications after hospital discharge as they normally would.

Detailed Description:

The objective of this research is to reduce the incidence of post-discharge medication discrepancies, preventable and ameliorable ADEs, hospital readmissions, and ED visits through the use of HIT. The proposed tool will prompt primary care physicians to perform medication reconciliation at the first post-discharge outpatient visit, clearly display and organize preadmission and discharge medication regimens, and facilitate the creation of the new post-discharge medication list with just a few keystrokes. Using methodologies from prior studies at BWH, we will evaluate the intervention in a two-site RCT. The study will be conducted at Brigham and Women's Hospital and Massachusetts General Hospital, taking advantage of our rich experience with designing and testing new informatics applications, including one for inpatient medication reconciliation.

  Eligibility

Ages Eligible for Study:   55 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Patients admitted to BWH or MGH who plan to follow up with a PCP in one of 12 primary care practices affiliated with BWH or MGH.
  • Patients will need to meet the following criteria:

    • 1) be 55 years or older,
    • 2) be admitted to the participating delivery system's hospital during the study period for a non-psychiatric condition,
    • 3) have no plans to enter hospice,
    • 4) be discharged back to the community,
    • 5) be prescribed 5 or more medications at discharge, including at least one of the following:

      • antibiotics,
      • insulin,
      • antihypertensives,
      • anti-rejection,
      • antiarrhythmics,
      • inhalers,
      • antiepileptics,
      • antianginals,
      • pain medications,
      • oral hypoglycemics,
      • steroids,
      • anticoagulants.
    • These drugs were selected because they require close monitoring, increase risk for drug-drug interactions, have a narrow therapeutic window, or are known to increase risk for ADEs in the older adult population

Exclusion Criteria:

Unable to provide informed consent and has no proxy who administers patient's medications and can provide informed consent

  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00740675

Locations
United States, Massachusetts
Brigham & Women's Hospital
Boston, Massachusetts, United States, 02120
Massachusetts General Hospital
Boston, Massachusetts, United States, 02114
Sponsors and Collaborators
Brigham and Women's Hospital
Investigators
Study Director: David W Bates, MD, MSc Brigham and Women's Hospital
  More Information

No publications provided

Responsible Party: Jeffrey L. Schnipper, MD, MPH, Brigham and Women's Hospital
ClinicalTrials.gov Identifier: NCT00740675     History of Changes
Other Study ID Numbers: 1U18 HS016790-01
Study First Received: December 28, 2007
Last Updated: January 5, 2011
Health Authority: United States: Institutional Review Board

Keywords provided by Brigham and Women's Hospital:
adverse drug events
outpatient

Additional relevant MeSH terms:
Drug Toxicity
Poisoning
Substance-Related Disorders

ClinicalTrials.gov processed this record on April 17, 2014