Adverse drug events (ADEs) are the most clinically significant and costly medication-related problems in nursing homes (NH) and are associated with an estimated 93,000 deaths a year and in as much as $4 billion of excess healthcare expenditures. Current ADE detection and management strategies that rely on pharmacist retrospective chart reviews (i.e., usual care) are inadequate. Active medication monitoring systems are recommended by many safety organizations as an alternative to detect and manage ADEs. These systems have been shown to be less expensive, faster, and identify ADEs not normally detected by clinicians in the hospital setting. We developed and pilot-tested an active medication monitoring system for use in a single NH, where it was shown to detect ADEs with a high degree of accuracy and at a rate of nearly 2.5 times that of usual care. The long-term objective of our proposed research is to improve patient safety with respect to medications in NHs. The short-term objectives or specific aims of our proposed research are to determine if NH patients managed by physicians who receive active medication monitoring alerts have more ADEs detected, have a faster ADE management response time, and can result in more cost-savings from a societal perspective compared to usual care. To accomplish these aims, we will conduct a cluster randomized controlled trial among 86 NH physicians working in one of 4 NHs in Southwestern PA for a period of 12 months. Our hypotheses are that NH patients managed by physicians who receive active medication monitoring alerts will have more ADEs detected, will have a faster ADE management response time, and will result in cost-savings from a societal perspective compared to usual care. This application by an early stage investigator is responsive to PA-09- 070 AHRQ Health Services Research Projects and several of its research portfolio priority areas (health information technology, patient safety, and value) by addressing how medication management systems can be used to improve the quality and safety of medication management, as well as improve healthcare decision making. This study represents the first large, well-controlled, comprehensive examination of an active medication monitoring system in the NH.

Public Health Relevance

PROJECT NARRATIVE/

Public Health Relevance

- If proven effective, the results of our study should have broad clinical and policy implications. From a clinical perspective, it will help physicians detect ADEs more frequently and respond to them more efficiently. From a policy perspective, if shown to result in cost-savings, our results can be used to inform pharmacy regulations that promote more widespread use of active medication monitoring systems.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
5R01HS018721-03
Application #
8250793
Study Section
Health Care Technology and Decision Science (HTDS)
Program Officer
Perfetto, Deborah
Project Start
2010-05-01
Project End
2014-04-30
Budget Start
2012-05-01
Budget End
2013-04-30
Support Year
3
Fiscal Year
2012
Total Cost
Indirect Cost
Name
University of Pittsburgh
Department
Miscellaneous
Type
Schools of Medicine
DUNS #
004514360
City
Pittsburgh
State
PA
Country
United States
Zip Code
15213
Driessen, Julia; Bonhomme, Andro; Chang, Woody et al. (2016) Nursing Home Provider Perceptions of Telemedicine for Reducing Potentially Avoidable Hospitalizations. J Am Med Dir Assoc 17:519-24
Smith, Kenneth J; Handler, Steven M; Kapoor, Wishwa N et al. (2016) Automated Communication Tools and Computer-Based Medication Reconciliation to Decrease Hospital Discharge Medication Errors. Am J Med Qual 31:315-22
Lo-Ciganic, Wei-Hsuan; Perera, Subashan; Gray, Shelly L et al. (2015) Statin use and decline in gait speed in community-dwelling older adults. J Am Geriatr Soc 63:124-9
Aspinall, Sherrie L; Zhao, Xinhua; Semla, Todd P et al. (2015) Epidemiology of drug-disease interactions in older veteran nursing home residents. J Am Geriatr Soc 63:77-84
Kane-Gill, Sandra L; Sileanu, Florentina E; Murugan, Raghavan et al. (2015) Risk factors for acute kidney injury in older adults with critical illness: a retrospective cohort study. Am J Kidney Dis 65:860-9
Culley, Colleen M; Perera, Subashan; Marcum, Zachary A et al. (2015) Using a Clinical Surveillance System to Detect Drug-Associated Hypoglycemia in Nursing Home Residents. J Am Geriatr Soc 63:2125-9
Marcum, Zachary A; Driessen, Julia; Thorpe, Carolyn T et al. (2015) Regional variation in use of a new class of antidiabetic medication among medicare beneficiaries: the case of incretin mimetics. Ann Pharmacother 49:285-92
Boyce, R D; Perera, S; Nace, D A et al. (2014) A survey of nursing home physicians to determine laboratory monitoring adverse drug event alert preferences. Appl Clin Inform 5:895-906
Handler, Steven M; Cheung, Pui Wen; Culley, Colleen M et al. (2014) Determining the incidence of drug-associated acute kidney injury in nursing home residents. J Am Med Dir Assoc 15:719-24
Nace, David A; Drinka, Paul J; Crnich, Christopher J (2014) Clinical uncertainties in the approach to long term care residents with possible urinary tract infection. J Am Med Dir Assoc 15:133-9

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