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

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: NCT01004328
Recruitment Status : Completed
First Posted : October 29, 2009
Last Update Posted : April 24, 2014
Information provided by (Responsible Party):
Terry Field, University of Massachusetts, Worcester

Brief Summary:
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 or disease Intervention/treatment Phase
Adverse Outcomes Other: Intervention 1: Electronic medical record (EMR)-based transitional care intervention Not Applicable

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 626 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Health Services Research
Official Title: Using HIT to Improve Transitions of Complex Elderly Patients From SNF to Home
Study Start Date : April 2011
Actual Primary Completion Date : June 2012
Actual Study Completion Date : January 2013

Arm Intervention/treatment
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

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

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

Information from the National Library of Medicine

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Ages Eligible for Study:   65 Years and older   (Older Adult)
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.

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): NCT01004328

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United States, Massachusetts
Fallon Clinic
Worcester, Massachusetts, United States, 01605
Sponsors and Collaborators
University of Massachusetts, Worcester
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Principal Investigator: Terry S Field, DSc University of Massachusetts Medical School/Meyers Primary Care Institute
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Responsible Party: Terry Field, Associate Professor, Meyers Primary Care Institute/University of Massachusetts Medical School., University of Massachusetts, Worcester Identifier: NCT01004328    
Other Study ID Numbers: 1R18HS017817 ( U.S. AHRQ Grant/Contract )
First Posted: October 29, 2009    Key Record Dates
Last Update Posted: April 24, 2014
Last Verified: April 2014
Keywords provided by Terry Field, University of Massachusetts, Worcester:
patient safety
care transitions
therapeutic monitoring
skilled nursing facilities
Adverse outcomes after discharge from a SNF to home