Joshua Pevnick, MD, MSHS is a general internist with Assistant Professor appointments at Cedars-Sinai Health System (CSHS) and UCLA. He practices hospital medicine and has been conducting health services research (HSR) focusing on information technology interventions to improve medication management. Recently, he has seen that those likely to benefit most from his work are older adults, as they have the most complex medication regimens, the least ability to remember these regimens, and the least physiologic reserve to tolerate adverse drug events. Furthermore, almost all of his clinical work and research is conducted at CSHS, which is known to have a disproportionately older population. Finally, this issue is best addressed in a patient-centric, rather than solution-centri, manner. For all of these reasons, further geriatric training would substantially benefit his research. He has thus recently changed his career goal to: Become a leading health services researcher advancing the study of medication management in seniors at care transitions. To achieve this goal, Dr. Pevnick proposes a mentoring plan involving regular meetings with four mentors: Douglas Bell, MD, PhD (content expertise in informatics, methodological expertise in HSR), Catherine Sarkisian, MD, MSPH (content expertise in geriatrics, methodological expertise in HSR), Cynthia Jackevicius, PharmD (content expertise in pharmaceutical sciences, methodological expertise in HSR), and Andre Rogatko, PhD (methodological expertise in biostatistics and trial design). His career development will also be supported by training plans emphasizing geriatrics, clinical trial design, grantwriting and medical informatics. Finally, he wil conduct a research project to generate results important for their own sake, to serve as a vehicle to apply what he learns from mentors and classes, and to build a foundation for future research proposals. Dr. Pevnick proposes to study three interventions to improve the accuracy of medication histories obtained at hospital admission. The interventions will target older adult patients prone to erroneous medication histories and concomitant medication errors. For predominantly older patients on complex home medication regimens, Dr. Pevnick is conducting a randomized controlled trial (RCT) to test the effect of using pharmacists and pharmacy technicians to obtain an initial admission medication history (AMH) on its accuracy. He will retrospectively study the potential benefit of accessing electronic medication fill data at the tim of admission to improve AMH accuracy. After analyzing both how these interventions affect AMH accuracy and the labor costs for these interventions, Dr. Pevnick will lead the design and refinement of a combined intervention targeted at seniors, which will ultimately be tested in a second RCT. Improving AMH accuracy is accepted as a necessary first step in preventing adverse drug events, which cause over 100,000 deaths in hospitalized US patients annually. Beyond studying potential solutions to this public health threat, this research project will provid Dr. Pevnick the opportunity to develop himself into a leading independent investigator in aging science.
Prior research shows that medication histories obtained by providers at hospital admission are fraught with errors, and that these errors lead to substantial morbidity and mortality in older adults. This project will develop and test new methods of obtaining more accurate medication histories, using pharmacists, pharmacy technicians, and electronic data indicating which medications patients have recently purchased. Improving this process has the potential to benefit millions of US patients annually, and to reduce deaths due to adverse drug events in hospitalized patients, which have been estimated to exceed 100,000 annually.
