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

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.

Study Overview

• Status: Completed
• Conditions: Adverse Outcomes
• Intervention / Treatment: Other: Intervention 1: Electronic medical record (EMR)-based transitional care intervention

• Study Type: Interventional
• Enrollment (Actual): 626
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Massachusetts
    • Worcester, Massachusetts, United States, 01605
      • Fallon Clinic

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years and older (Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

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.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / 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

What is the study measuring?

Primary Outcome Measures

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

Secondary Outcome Measures

Outcome Measure	Time Frame
Determine costs directly related to the development and installation of the HIT-based transitional care intervention	3 years

Collaborators and Investigators

• Sponsor: University of Massachusetts, Worcester
• Investigators: Principal Investigator: Terry S Field, DSc, University of Massachusetts Medical School/Meyers Primary Care Institute

Study record dates

Study Major Dates

• Study Start: April 1, 2011
• Primary Completion (Actual): June 1, 2012
• Study Completion (Actual): January 1, 2013

Study Registration Dates

• First Submitted: July 22, 2009
• First Submitted That Met QC Criteria: October 28, 2009
• First Posted (Estimate): October 29, 2009

Study Record Updates

• Last Update Posted (Estimate): April 24, 2014
• Last Update Submitted That Met QC Criteria: April 23, 2014
• Last Verified: April 1, 2014

More Information

Terms related to this study

• Keywords: patient safety; care transitions; therapeutic monitoring; skilled nursing facilities; Adverse outcomes after discharge from a SNF to home
• Other Study ID Numbers: 1R18HS017817 (U.S. AHRQ Grant/Contract); 13001 (Australasian Lung Trials Group)