Communication between physicians caring for a patient in the hospital and that patient's primary care provider is less than optimal, and can lead to diminished health care quality and safety. This project will lead to better communication between physicians and could decrease medication errors that tend to occur as the patient goes from hospital to home.
Communication between physicians caring for hospitalized patients and those patients' primary care providers (PCPs) is often suboptimal. Hospital-based information systems can improve communication by automating information exchange between hospital physicians and PCPs, and perhaps, as a result, improve the quality and safety of health care. MedTrak, the University of Pittsburgh Medical Center (UPMC) electronic physician communication tool, has proven successful and is poised to move forward with an initiative the investigators call virtual continuity, allowing PCPs to follow their patients electronically if they cannot do so physically. Virtual continuity will include: emails to PCPs triggered by clinical events with embedded links to electronic medical record data and communication portals, medication lists electronically delivered to PCPs at admission and discharge, and immediate PCP notification of discharge with pertinent clinical details. To evaluate virtual continuity, the investigators will examine the frequency of discharge medication errors in complex medical patients using a pre-post study design of virtual continuity compared to usual communication. Medication errors will be ascertained using accepted methods. The investigators will also investigate differences in rehospitalization, post discharge emergency department visit and PCP follow up rates. The IT cost of implementing and maintaining the virtual continuity intervention will also be assessed. Virtual continuity will allow PCPs to participate more directly in the care of their hospitalized patients. Improved communication could lead to higher-quality patient care and greater patient care safety for hospitalized patients with complex medical problems.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
835
Automated communication tools will include: * PCP notification of patient admission and location * Data on medications begun on admission * Automated alerts on changes in patient status and location while the patient is hospitalized * Links to the EMR and to hospital physician contact information on all email alerts * Real-time delivery of discharge information (medications, instructions, and follow-up) to the PCP * Automatic reporting to PCPs of test results pending at discharge * Electronic delivery of final discharge summaries
UPMC Presbyterian Hospital
Pittsburgh, Pennsylvania, United States
Medication Errors at Hospital Discharge
Medication name, dose, and frequency of administration for patient pre-admission medications will be recorded. Medications received during the hospitalization and discharge medications will be obtained by medical record review following hospital discharge. Pre-admission medications will be compared to discharge medications and differences will be considered discharge medication variances. Two trained pharmacists will independently review medication variances to determine clinical indications or medication errors.
Time frame: Approximately 1-30 days
Patient PCP Visits, Emergency Room Visits and Rehospitalizations Within 30 Days Post-discharge.
Details regarding patient PCP follow-up office appointments, ER visits and rehospitalizations occuring within 30 days post-discharge will be collected from the EMR.
Time frame: Within 30 post-discharge from hospital
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