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


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.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
Project #
Application #
Study Section
Health Care Technology and Decision Science (HTDS)
Program Officer
Perfetto, Deborah
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Pittsburgh
Schools of Medicine
United States
Zip Code
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
Nace, David A; Drinka, Paul J (2014) Cranberry capsules reducing the incidence of what? J Am Geriatr Soc 62:1616-7
Ligons, Frank M; Mello-Thoms, Claudia; Handler, Steven M et al. (2014) Assessing the impact of cognitive impairment on the usability of an electronic medication delivery unit in an assisted living population. Int J Med Inform 83:841-8
Marcum, Zachary A; Driessen, Julia; Thorpe, Carolyn T et al. (2014) Effect of multiple pharmacy use on medication adherence and drug-drug interactions in older adults with Medicare Part D. J Am Geriatr Soc 62:244-52
Maher, Robert L; Hanlon, Joseph; Hajjar, Emily R (2014) Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf 13:57-65
Wagner, Laura M; Castle, Nicholas G; Handler, Steven M (2013) Use of HIT for adverse event reporting in nursing homes: barriers and facilitators. Geriatr Nurs 34:112-5
Romagnoli, Katrina M; Handler, Steven M; Hochheiser, Harry (2013) Home care: more than just a visiting nurse. BMJ Qual Saf 22:972-4
Romagnoli, Katrina M; Handler, Steven M; Ligons, Frank M et al. (2013) Home-care nurses' perceptions of unmet information needs and communication difficulties of older patients in the immediate post-hospital discharge period. BMJ Qual Saf 22:324-32
Marcum, Zachary A; Arbogast, Kelly L; Behrens, Michael C et al. (2013) Utility of an adverse drug event trigger tool in Veterans Affairs nursing facilities. Consult Pharm 28:99-109

Showing the most recent 10 out of 30 publications