- ICH GCP
- Registre américain des essais cliniques
- Essai clinique NCT01397253
Virtual Continuity and Its Impact on Complex Hospitalized Patients' Care
27 mars 2015 mis à jour par: 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.
Aperçu de l'étude
Statut
Complété
Les conditions
Intervention / Traitement
Description détaillée
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.
Type d'étude
Interventionnel
Inscription (Réel)
835
Phase
- Phase 3
Contacts et emplacements
Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.
Lieux d'étude
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Pennsylvania
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Pittsburgh, Pennsylvania, États-Unis, 15213-2582
- UPMC Presbyterian Hospital
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Critères de participation
Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.
Critère d'éligibilité
Âges éligibles pour étudier
18 ans et plus (Adulte, Adulte plus âgé)
Accepte les volontaires sains
Non
Sexes éligibles pour l'étude
Tout
La description
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
Plan d'étude
Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Recherche sur les services de santé
- Répartition: Non randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Seul
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
---|---|
Aucune intervention: (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.
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Expérimental: 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.
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Automated communication tools will include:
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
---|---|---|
Medication Errors at Hospital Discharge
Délai: Approximately 1-30 days
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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.
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Approximately 1-30 days
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Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
---|---|---|
Patient PCP Visits, Emergency Room Visits and Rehospitalizations Within 30 Days Post-discharge.
Délai: Within 30 post-discharge from hospital
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Details regarding patient PCP follow-up office appointments, ER visits and rehospitalizations occuring within 30 days post-discharge will be collected from the EMR.
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Within 30 post-discharge from hospital
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Collaborateurs et enquêteurs
C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.
Parrainer
Collaborateurs
Les enquêteurs
- Chercheur principal: Kenneth J Smith, MD, MS, University of Pittsburgh Medical Center, University of Pittsburgh
Publications et liens utiles
La personne responsable de la saisie des informations sur l'étude fournit volontairement ces publications. Il peut s'agir de tout ce qui concerne l'étude.
Publications générales
- 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.
Dates d'enregistrement des études
Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.
Dates principales de l'étude
Début de l'étude
1 août 2010
Achèvement primaire (Réel)
1 janvier 2013
Achèvement de l'étude (Réel)
1 janvier 2013
Dates d'inscription aux études
Première soumission
15 juillet 2011
Première soumission répondant aux critères de contrôle qualité
18 juillet 2011
Première publication (Estimation)
19 juillet 2011
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Estimation)
16 avril 2015
Dernière mise à jour soumise répondant aux critères de contrôle qualité
27 mars 2015
Dernière vérification
1 mars 2015
Plus d'information
Termes liés à cette étude
Autres numéros d'identification d'étude
- 3130920
Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .
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