Partnering With Patients for Improving Medication Safety During Transitions of Care: Implications for Work System Design

Summary

This project is to develop, implement, pilot evaluate, and disseminate a medication safety program (HomeTeam) that consolidates strategies to help patients by partnering with patients and their informal caregivers during transitions from hospital to home. Care transitions, especially from hospital to home, are high-risk periods for medication errors, and are frequently associated with serious adverse drug events (ADEs) and preventable readmissions. Older adults with multi-morbid conditions who have complex medication regimes are especially prone to these risks. Patients and family caregivers may experience a dramatic transition in roles and responsibilities immediately after hospital discharge. Patients and family caregivers are relatively passive recipients in their care and medication management in the hospital, but when patients arrive at home, patients have the primary responsibility for their care and medication use (with professional care providers switching to a 'supporting' function). Although this significant transition in the nature and intensity of patient work needs to be managed actively, often patients and family members are not adequately engaged and prepared in the hospital, and not effectively supported for safe medication use after hospital discharge. More specifically, patients and family members may not understand essential steps in the management of their condition, and have difficulty contacting appropriate health care practitioners for guidance. Although most organizations deploy multiple layers of interventions for improving care transitions, reducing postdischarge adverse drug events (ADEs), 30-day readmissions and emergency department (ED) visits, their impact to date has been small, and there remains significant and urgent need to fundamentally redesign the hospital-to-home care transition process. Investigators believe that one practical and potentially effective way for this 'much-needed' redesign is through engaging and supporting patients and families in safe medication use. Investigators' proposed program 'HomeTeam' will contain evidence-based tools and methods for engaging patients and shifting culture towards a truly patient-centered care for medication safety.

Conditions

• Patient Safety
• Adverse Drug Event

Interventions

BEHAVIORAL

HomeTeam Toolkit

A multi-component intervention (8S's) 1. Safety at home through partnership. 2. Safety risk assessment at the admission 3. Safety agenda setting for coordinating efforts among professionals to prepare patient/ family for self-management 4. Safety tools. Cognitive tools to support patient/family after discharge 5. Safety education. Enhanced Patient/ family medication safety education 6. Safety briefings with patient/family A mechanism to proactively address common and patient/family specific risks. 7. Safety through learning routines across the care continuum 8. Safety assessment after discharge

Sponsors & Collaborators

• The University of Texas at Arlington

  collaborator OTHER

• Johns Hopkins University

  lead OTHER

Principal Investigators

• Ayse Gurses · Johns Hopkins University

Study Design

Allocation

NON_RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

65 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2019-12-31

Primary Completion

2022-08-31

Completion

2022-10-31

Countries

• United States

Study Locations