VA Integrated Medication Manager (IMM)
2016年5月17日 更新者：University of Utah
Veterans Affairs Integrated Medication Manager
The purpose of this study is to advance the science of healthcare informatics and to improve medication management through the development of a new approach to the electronic medical record called the Integrated Medication Manager (IMM).
調査の概要
詳細な説明
In an attempt to address problems patient non-compliance with quality goals barriers to access and integration of health information that impede achievement of treatment goals, the VA is developing a new approach to the electronic medical record. The VA is moving away from the paper-chart metaphor and towards an integrated representation of the patient's status and care process across time. One of the first steps in the development phase has been to explicitly relate patient conditions, therapies, and goals in the domain of pharmacotherapy. This is called Integrated Medication Management and draws on Hollnagel's Contextual Control Model. Providers will be able to plan care and create orders directly in the context of these explicit relationships. This application will be implemented nationwide through a web interface embedded within the existing Computerized Patient Record System (CPRS), the graphical user interface to VA Information Systems (VistA).
Aim 1: Identify cognitive components of providers' therapeutic decision making in the field.
Aim 2. Refine and evaluate the Integrated Medication Manager using simulation studies.
- Aim 2.a. Refine interfaces and logic of the Integrated Medication Manager.
- Aim 2.b. Compare the performance of the Integrated Medication Manager and usual CPRS.
All hypotheses (below) test the use of IMM versus usual electronic medical record (EMR).
- Speed of decision-making will be faster.
- Accuracy of data interpretation (clinical assessment) will be higher.
- Appropriateness of therapeutic plans will be higher.
- Efficiency of gathering information will be higher.
- Common ground measures will be higher.
- Appropriateness of therapeutic plans will be higher when relevant data is outside the usual time horizon.
- Appropriateness of therapeutic plans will be higher when complex associations among patient therapies and goals exist.
- Appropriateness of therapeutic plans will be no lower when relevant data is not captured by the displays of the IMM.
- Appropriateness of therapeutic plans will be higher when highly salient data is not germane to the most important problem.
- Appropriateness of therapeutic plans will be higher when cognitive load is high due to interruptions.
研究の種類
介入
入学 (実際)
58
段階
- 適用できない
連絡先と場所
このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。
研究場所
-
-
Utah
-
Salt Lake City、Utah、アメリカ、84148
- VA SLC Health Care System
-
-
参加基準
研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。
適格基準
就学可能な年齢
18年歳以上 (大人、高齢者)
健康ボランティアの受け入れ
はい
受講資格のある性別
全て
説明
Inclusion Criteria:
- Practiced in primary care for at least two years
- Third year residents with two years of residency in internal medicine or family practice
- Do not have to be currently practicing
Exclusion Criteria:
- None
研究計画
このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。
研究はどのように設計されていますか？
デザインの詳細
- 主な目的：ヘルスサービス研究
- 割り当て：ランダム化
- 介入モデル：並列代入
- マスキング：なし（オープンラベル）
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
|
実験的：Integrated Medication Manager
Experienced providers that participated in the EHR simulations.
Half of the providers were assigned to use the new Integrated Medication Manager (intervention) during the simulation.
The other half were assigned the VA's CPRS to use (standard EHR).
Providers were randomly assigned which system to use.
|
A theory based electronic health record.
Half of the provider participants were assigned the IMM to use.
The other half were assigned the VA's CPRS EHR to use for the simulation.
Providers were randomly assigned to a EHR to use.
他の名前：
|
|
介入なし：Standard EHR
Experienced providers that participated in the EHR simulations.
Half of the providers were assigned to use the new Integrated Medication Manager (intervention) during the simulation.
The other half were assigned the VA's CPRS to use (standard EHR).
Providers were randomly assigned which system to use.
|
この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Amount of Time to Complete Assessment and Plan
時間枠：10 minutes
|
Each participant had 10 minutes maximum to review the patient case and write an Assessment and Plan.
|
10 minutes
|
|
Accuracy of Written Assessment and Plan in Terms of Control and Status
時間枠：10 minutes
|
Each participant had 10 minutes maximum to review the patient case and write an Assessment and Plan.
The primary outcome evaluated participants' recommendations for treatment of patient conditions.
Participants reviewed a total of 10 patient cases and received a score between 0 and 3 points for each issue within each patient case.
The final score for each participant was a proportion between 0 and 1.
The proportion represented the sum of all points assigned to the participant, divided by the total number of points possible.
Higher values on the scale represent greater accuracy of the written assessment and plan.
|
10 minutes
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Identification of Planned Monitoring and Follow up Encounters in Assessment and Plan
時間枠：10 minutes
|
Each participant had 10 minutes maximum to review the patient case and write an Assessment and Plan. .
The secondary outcome evaluated participants' recommendation about future monitoring of patient conditions.
Participants reviewed a total of 10 patient cases and received a score of 0 or 1 point for each issue within each case.
The final score for each participant was a proportion between 0 and 1.
The proportion represented the sum of all points assigned to the participant, divided by the total number of points possible.
Higher values on the scale represent a greater proportion of appropriate monitoring recommendations made.
|
10 minutes
|
協力者と研究者
ここでは、この調査に関係する人々や組織を見つけることができます。
スポンサー
捜査官
- 主任研究者：Jonathan Nebeker, MD, MS、University of Utah
出版物と役立つリンク
研究に関する情報を入力する責任者は、自発的にこれらの出版物を提供します。これらは、研究に関連するあらゆるものに関するものである可能性があります。
一般刊行物
- Phillips LS, Branch WT, Cook CB, Doyle JP, El-Kebbi IM, Gallina DL, Miller CD, Ziemer DC, Barnes CS. Clinical inertia. Ann Intern Med. 2001 Nov 6;135(9):825-34. doi: 10.7326/0003-4819-135-9-200111060-00012.
- Crosson JC, Stroebel C, Scott JG, Stello B, Crabtree BF. Implementing an electronic medical record in a family medicine practice: communication, decision making, and conflict. Ann Fam Med. 2005 Jul-Aug;3(4):307-11. doi: 10.1370/afm.326.
- Tinetti ME, Bogardus ST Jr, Agostini JV. Potential pitfalls of disease-specific guidelines for patients with multiple conditions. N Engl J Med. 2004 Dec 30;351(27):2870-4. doi: 10.1056/NEJMsb042458. No abstract available.
- Asch SM, McGlynn EA, Hogan MM, Hayward RA, Shekelle P, Rubenstein L, Keesey J, Adams J, Kerr EA. Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample. Ann Intern Med. 2004 Dec 21;141(12):938-45. doi: 10.7326/0003-4819-141-12-200412210-00010.
- Garg AX, Adhikari NK, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, Sam J, Haynes RB. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 2005 Mar 9;293(10):1223-38. doi: 10.1001/jama.293.10.1223.
- Perlin JB, Pogach LM. Improving the outcomes of metabolic conditions: managing momentum to overcome clinical inertia. Ann Intern Med. 2006 Apr 4;144(7):525-7. doi: 10.7326/0003-4819-144-7-200604040-00012. No abstract available.
- Morris AH. Developing and implementing computerized protocols for standardization of clinical decisions. Ann Intern Med. 2000 Mar 7;132(5):373-83. doi: 10.7326/0003-4819-132-5-200003070-00007.
- Fox J, Alabassi A, Black E, Hurt C, Rose T. Modelling clinical goals: a corpus of examples and a tentative ontology. Stud Health Technol Inform. 2004;101:31-45.
- Xiao Y, Hunter WA, Mackenzie CF, Jefferies NJ, Horst RL. Task complexity in emergency medical care and its implications for team coordination. LOTAS Group. Level One Trauma Anesthesia Simulation. Hum Factors. 1996 Dec;38(4):636-45. doi: 10.1518/001872096778827206.
- Nebeker JR, Hurdle JF, Bair BD. Future history: medical informatics in geriatrics. J Gerontol A Biol Sci Med Sci. 2003 Sep;58(9):M820-5. doi: 10.1093/gerona/58.9.m820.
- Hayward RA, Asch SM, Hogan MM, Hofer TP, Kerr EA. Sins of omission: getting too little medical care may be the greatest threat to patient safety. J Gen Intern Med. 2005 Aug;20(8):686-91. doi: 10.1111/j.1525-1497.2005.0152.x.
- Shekelle PG. Invited commentary: Implementation of health information technology: an important but challenging field of inquiry. Proc (Bayl Univ Med Cent). 2006 Oct;19(4):313. doi: 10.1080/08998280.2006.11928190. No abstract available.
- Weir CR, Nebeker JJ, Hicken BL, Campo R, Drews F, Lebar B. A cognitive task analysis of information management strategies in a computerized provider order entry environment. J Am Med Inform Assoc. 2007 Jan-Feb;14(1):65-75. doi: 10.1197/jamia.M2231. Epub 2006 Oct 26.
- Berg CA, Strough JN, Calderone KS, Sansone C, Weir C. The role of problem definitions in understanding age and context effects on strategies for solving everyday problems. Psychol Aging. 1998 Mar;13(1):29-44. doi: 10.1037//0882-7974.13.1.29.
- Weir CR. Linking information needs with evaluation: the role of task identification. Proc AMIA Symp. 1998:310-4.
- Taatz H. [The problem of the time factor in orthodontic treatment]. Stomatol DDR. 1976 Feb;26(2):102-5. No abstract available. German.
- Campbell M, Grimshaw J, Steen N. Sample size calculations for cluster randomised trials. Changing Professional Practice in Europe Group (EU BIOMED II Concerted Action). J Health Serv Res Policy. 2000 Jan;5(1):12-6. doi: 10.1177/135581960000500105.
- Miller RH, Sim I. Physicians' use of electronic medical records: barriers and solutions. Health Aff (Millwood). 2004 Mar-Apr;23(2):116-26. doi: 10.1377/hlthaff.23.2.116.
- Bradley EH, Bogardus ST Jr, Tinetti ME, Inouye SK. Goal-setting in clinical medicine. Soc Sci Med. 1999 Jul;49(2):267-78. doi: 10.1016/s0277-9536(99)00107-0.
研究記録日
これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。
主要日程の研究
研究開始
2007年10月1日
一次修了 (実際)
2011年3月1日
研究の完了 (実際)
2011年3月1日
試験登録日
最初に提出
2013年1月22日
QC基準を満たした最初の提出物
2013年2月5日
最初の投稿 (見積もり)
2013年2月8日
学習記録の更新
投稿された最後の更新 (見積もり)
2016年6月23日
QC基準を満たした最後の更新が送信されました
2016年5月17日
最終確認日
2016年5月1日
詳しくは
本研究に関する用語
キーワード
その他の研究ID番号
- 5R18HS017186-03 (米国 AHRQ グラント/契約)
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。