- ICH GCP
- US Clinical Trials Registry
- Klinisk forsøg NCT01397253
Virtual Continuity and Its Impact on Complex Hospitalized Patients' Care
27. marts 2015 opdateret af: University of Pittsburgh
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.
Studieoversigt
Status
Afsluttet
Intervention / Behandling
Detaljeret beskrivelse
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.
Undersøgelsestype
Interventionel
Tilmelding (Faktiske)
835
Fase
- Fase 3
Kontakter og lokationer
Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.
Studiesteder
-
-
Pennsylvania
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Pittsburgh, Pennsylvania, Forenede Stater, 15213-2582
- UPMC Presbyterian Hospital
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-
Deltagelseskriterier
Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.
Berettigelseskriterier
Aldre berettiget til at studere
18 år og ældre (Voksen, Ældre voksen)
Tager imod sunde frivillige
Ingen
Køn, der er berettiget til at studere
Alle
Beskrivelse
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
Studieplan
Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Sundhedstjenesteforskning
- Tildeling: Ikke-randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Enkelt
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
---|---|
Ingen indgriben: (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.
|
|
Eksperimentel: 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.
|
Automated communication tools will include:
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Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
---|---|---|
Medication Errors at Hospital Discharge
Tidsramme: 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.
|
Approximately 1-30 days
|
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
---|---|---|
Patient PCP Visits, Emergency Room Visits and Rehospitalizations Within 30 Days Post-discharge.
Tidsramme: 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.
|
Within 30 post-discharge from hospital
|
Samarbejdspartnere og efterforskere
Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.
Sponsor
Samarbejdspartnere
Efterforskere
- Ledende efterforsker: Kenneth J Smith, MD, MS, University of Pittsburgh Medical Center, University of Pittsburgh
Publikationer og nyttige links
Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.
Generelle publikationer
- Kripalani S, Jackson AT, Schnipper JL, Coleman EA. Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists. J Hosp Med. 2007 Sep;2(5):314-23. doi: 10.1002/jhm.228.
- Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007 Feb 28;297(8):831-41. doi: 10.1001/jama.297.8.831.
- Halasyamani L, Kripalani S, Coleman E, Schnipper J, van Walraven C, Nagamine J, Torcson P, Bookwalter T, Budnitz T, Manning D. Transition of care for hospitalized elderly patients--development of a discharge checklist for hospitalists. J Hosp Med. 2006 Nov;1(6):354-60. doi: 10.1002/jhm.129.
- Coleman EA, Boult C; American Geriatrics Society Health Care Systems Committee. Improving the quality of transitional care for persons with complex care needs. J Am Geriatr Soc. 2003 Apr;51(4):556-7. doi: 10.1046/j.1532-5415.2003.51186.x. No abstract available.
- Coleman EA, Mahoney E, Parry C. Assessing the quality of preparation for posthospital care from the patient's perspective: the care transitions measure. Med Care. 2005 Mar;43(3):246-55. doi: 10.1097/00005650-200503000-00007.
Datoer for undersøgelser
Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.
Studer store datoer
Studiestart
1. august 2010
Primær færdiggørelse (Faktiske)
1. januar 2013
Studieafslutning (Faktiske)
1. januar 2013
Datoer for studieregistrering
Først indsendt
15. juli 2011
Først indsendt, der opfyldte QC-kriterier
18. juli 2011
Først opslået (Skøn)
19. juli 2011
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Skøn)
16. april 2015
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
27. marts 2015
Sidst verificeret
1. marts 2015
Mere information
Begreber relateret til denne undersøgelse
Andre undersøgelses-id-numre
- 3130920
Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .
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