VA Integrated Medication Manager (IMM)
17 mei 2016 bijgewerkt door: 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).
Studie Overzicht
Toestand
Voltooid
Conditie
Interventie / Behandeling
Gedetailleerde beschrijving
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.
Studietype
Ingrijpend
Inschrijving (Werkelijk)
58
Fase
- Niet toepasbaar
Contacten en locaties
In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.
Studie Locaties
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Utah
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Salt Lake City, Utah, Verenigde Staten, 84148
- VA SLC Health Care System
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Deelname Criteria
Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
18 jaar en ouder (Volwassen, Oudere volwassene)
Accepteert gezonde vrijwilligers
Ja
Geslachten die in aanmerking komen voor studie
Allemaal
Beschrijving
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
Studie plan
Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Onderzoek naar gezondheidsdiensten
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Geen (open label)
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
|---|---|
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Experimenteel: 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.
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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.
Andere namen:
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Geen tussenkomst: 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.
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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Amount of Time to Complete Assessment and Plan
Tijdsspanne: 10 minutes
|
Each participant had 10 minutes maximum to review the patient case and write an Assessment and Plan.
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10 minutes
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Accuracy of Written Assessment and Plan in Terms of Control and Status
Tijdsspanne: 10 minutes
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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.
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10 minutes
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Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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Identification of Planned Monitoring and Follow up Encounters in Assessment and Plan
Tijdsspanne: 10 minutes
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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.
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10 minutes
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Medewerkers en onderzoekers
Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.
Sponsor
Onderzoekers
- Hoofdonderzoeker: Jonathan Nebeker, MD, MS, University of Utah
Publicaties en nuttige links
De persoon die verantwoordelijk is voor het invoeren van informatie over het onderzoek stelt deze publicaties vrijwillig ter beschikking. Dit kan gaan over alles wat met het onderzoek te maken heeft.
Algemene publicaties
- 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.
Studie record data
Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.
Bestudeer belangrijke data
Studie start
1 oktober 2007
Primaire voltooiing (Werkelijk)
1 maart 2011
Studie voltooiing (Werkelijk)
1 maart 2011
Studieregistratiedata
Eerst ingediend
22 januari 2013
Eerst ingediend dat voldeed aan de QC-criteria
5 februari 2013
Eerst geplaatst (Schatting)
8 februari 2013
Updates van studierecords
Laatste update geplaatst (Schatting)
23 juni 2016
Laatste update ingediend die voldeed aan QC-criteria
17 mei 2016
Laatst geverifieerd
1 mei 2016
Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Andere studie-ID-nummers
- 5R18HS017186-03 (Amerikaanse AHRQ-subsidie/contract)
Deze informatie is zonder wijzigingen rechtstreeks van de website clinicaltrials.gov gehaald. Als u verzoeken heeft om uw onderzoeksgegevens te wijzigen, te verwijderen of bij te werken, neem dan contact op met register@clinicaltrials.gov. Zodra er een wijziging wordt doorgevoerd op clinicaltrials.gov, wordt deze ook automatisch bijgewerkt op onze website .