Medication Intervention in Transitional Care to Improve Outcomes in End-Stage Renal Disease
Providence Medical Research Center
9/1/2013 – 12/31/2015
Transitional care interventions reduce hospital readmissions and slow the progression of declining health in the general population of hospitalized patients. What is not known is the impact transitional care interventions can have for people with end stage renal disease (ESRD) treated by dialysis. Patients with ESRD are in critical need of improved transitional care that includes accurate and comprehensive medication information transfer. The main objective of this application is to pilot-test the effectiveness of a medication information transfer intervention to improve clinically-relevant outcomes in patients with ESRD treated by dialysis. To this end, the following Specific Aims will be achieved: 1. Evaluate the impact of transitional care interventions on acute care utilization following hospital discharge; and 2. Evaluate the impact of transitional care strategies on ESRD complications. The medication information transfer intervention will be evaluated in a pilot study using a randomized, single-blind clinical trial design. Participants and the pharmacist interventionist will have knowledge of group assignment, but the other investigators and research staff will be blinded. Study entry criteria will include hospitalized patients >21 years old (n=60) who have a diagnosis of ESRD treated by dialysis. After obtaining IRB-approved written informed consent, patients will be randomized by computer algorithm for group assignment, stratifying according to diabetes status and type of dialysis (hemodialysis or peritoneal dialysis).The pharmacist will visit participants randomized to the intervention group in the home within 5 days of hospital discharge. The 5As (Assessment, Advice, Agreement, Assistance, and Arrangements) Self-Management Model will be used to implement the medication information transfer intervention. Clinical assessments will be performed at baseline, 30 and 90 days. Primary outcome measures for Specific Aim 1 will be acute care utilization (emergency department visits and hospitalizations).The main outcomes for Specific Aim 2 will be measures of clinical complications (infections, cardiovascular events, other causes for hospital admission). Logistic regression analyses will be employed controlling for age, sex, diabetes, hypertension, and cardiovascular disease. Other co-morbidities may be entered in an exploratory forward stepwise approach, as sparse data are available regarding many such effects. Cost will be analyzed based on charges from hospitalization through the following 90 days using a difference-of difference approach. This contribution is significant because it will define methods to overcome system barriers that result in impaired quality and continuity of care. This research is innovative because it integrates established clinical strategies with systems approaches, thereby testing a fundamentally new approach to advance care for hospitalized patients with ESRD.
Cindy Corbett, PhD