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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.
Sponsor:
Information provided by (Responsible Party):
Terry Field, University of Massachusetts, Worcester
ClinicalTrials.gov Identifier:
NCT01004328
First received: July 22, 2009
Last updated: April 23, 2014
Last verified: April 2014

July 22, 2009
April 23, 2014
April 2011
June 2012   (final data collection date for primary outcome measure)
  • Rate of follow-up to an outpatient provider within 21 days of SNF discharge. [ Time Frame: 1 year 3 months ] [ Designated as safety issue: Yes ]
  • Prevalence of appropriate monitoring for selected high risk medications at 30 days from the time of SNF discharge. [ Time Frame: 1 year 3 months ] [ Designated as safety issue: Yes ]
  • Incidence of adverse drug events (ADEs) 45 days after discharge. [ Time Frame: 1 year 3 months ] [ Designated as safety issue: Yes ]
  • Rate of SNF readmission and emergency department (ED) within 30 days of discharge. [ Time Frame: 1 year 3 months ] [ Designated as safety issue: Yes ]
Same as current
Complete list of historical versions of study NCT01004328 on ClinicalTrials.gov Archive Site
Determine costs directly related to the development and installation of the HIT-based transitional care intervention [ Time Frame: 3 years ] [ Designated as safety issue: No ]
Same as current
Not Provided
Not Provided
 
Using Health Information Technology (HIT) to Improve Transitions of Complex Elderly Patients From Skilled Nursing Facility (SNF) to Home
Using HIT to Improve Transitions of Complex Elderly Patients From SNF to Home

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.

Not Provided
Interventional
Not Provided
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Health Services Research
Adverse Outcomes
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
Experimental: Intervention Group 1
All participants
Intervention: Other: Intervention 1: Electronic medical record (EMR)-based transitional care intervention
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
626
January 2013
June 2012   (final data collection date for primary outcome measure)

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.
Both
65 Years and older
Yes
Contact information is only displayed when the study is recruiting subjects
United States
 
NCT01004328
1R18HS017817, 13001
Yes
Terry Field, University of Massachusetts, Worcester
University of Massachusetts, Worcester
Not Provided
Principal Investigator: Terry S Field, DSc University of Massachusetts Medical School/Meyers Primary Care Institute
University of Massachusetts, Worcester
April 2014

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