Using Health Information Technology (HIT) to Improve Transitions of Complex Elderly Patients From Skilled Nursing Facility (SNF) to Home

Adverse Outcomes Clinical Trial

— RAMPAGEII  

Official title:

Using HIT to Improve Transitions of Complex Elderly Patients From SNF to Home

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01004328
• Other study ID #: 1R18HS017817
• Secondary ID: 13001
• Status: Completed
• Phase: N/A
• First received: July 22, 2009
• Last updated: April 23, 2014
• Start date: April 2011
• Est. completion date: January 2013

Study information

• Verified date: April 2014
• Source: University of Massachusetts, Worcester
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Institutional Review Board
• Study type: Interventional

Clinical Trial Summary

The incidence of drug-induced injury is high in the ambulatory geriatric population, especially for elders with complex healthcare needs during high risk transitions to the ambulatory setting. In a previous study funded by the National Institute on Aging and the Agency for Healthcare Research and Quality [AHRQ] (AG 15979), the investigators determined that drug-related injuries occur at a rate of more than 50 per 1000-patient years in older adults in the ambulatory setting and that 28% are preventable. Independent risk factors for adverse drug events among older adults in the ambulatory setting included advanced age, multiple comorbid conditions, and the use of medications requiring close monitoring. In this project, Using HIT to Improve Transitions of Complex Elderly Patients from SNF to Home (1 R18 HS017817), the investigators are testing the use of an electronic medical record (EMR)-based transitional care intervention for complex elderly patients transitioning from subacute care in a skilled nursing facility (SNF) to the ambulatory setting. The growing trend for physicians and other healthcare providers to restrict their practices to single settings and not follow complex patients as they move between settings leaves older patients discharged from subacute care particularly vulnerable. This transition is uniquely challenging because of the complex healthcare needs of this population, who often require outpatient primary care physicians to coordinate with visiting nurses in order to manage complex medication regimens and fluctuating clinical status. To facilitate high-quality transitions from the subacute to the ambulatory setting and support interdisciplinary communication, the investigators will use the EMR to assure that physicians in the ambulatory setting receive key health information and alerts.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 626
• Est. completion date: January 2013
• Est. primary completion date: June 2012
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: Both
• Age group: 65 Years and older

Eligibility

Inclusion Criteria:

• 65 years and older,

• Member of the study site health plan,

• Received care from one of the study site's geriatricians during a SNF stay,

• Discharged from SNF to home.

Exclusion Criteria:

• Does not meet inclusion criteria.

Study Design

Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Health Services Research

Related Conditions & MeSH terms

• Adverse Outcomes

Intervention

Other:
• Intervention 1: Electronic medical record (EMR)-based transitional care intervention
Electronic delivery of enhanced discharge information to the ambulatory physician with plans for follow-up appointment, notice of any new medications, and recommendations for laboratory monitoring

Locations

Country	Name	City	State
United States	Fallon Clinic	Worcester	Massachusetts

Sponsors (1)

Lead Sponsor	Collaborator
University of Massachusetts, Worcester

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Rate of follow-up to an outpatient provider within 21 days of SNF discharge.		1 year 3 months	Yes
Primary	Prevalence of appropriate monitoring for selected high risk medications at 30 days from the time of SNF discharge.		1 year 3 months	Yes
Primary	Incidence of adverse drug events (ADEs) 45 days after discharge.		1 year 3 months	Yes
Primary	Rate of SNF readmission and emergency department (ED) within 30 days of discharge.		1 year 3 months	Yes
Secondary	Determine costs directly related to the development and installation of the HIT-based transitional care intervention		3 years	No