Improving Post-Hospital Medication Management of Older Adults with Health Information Technology

Adverse drug events (ADEs), especially those that may be preventable, are among the most serious concerns about medication use in older people in ambulatory settings. A U.S. national surveillance study of emergency department (ED) visits for outpatient ADEs indicated that individuals aged 65 years or older were 2.4 times more likely than younger individuals to sustain ADEs, and nearly 7 times more likely to require hospitalization. Multiple factors, including poor physician-patient communication and education regarding medication use, poor therapeutic monitoring, and incomplete or inaccurate information transfer between clinicians contribute to problematic medication management following acute care. During care transitions, patients receive medications from different prescribers who often lack access to patients’ comprehensive medication lists. In addition, any lack of appropriate followup care exacerbates problems during this vulnerable period.

The goals of this study were to evaluate the impact of providing information through an electronic medical record-based transitional care intervention on the care of older adults discharged from the hospital. The specific aims of the study were to evaluate:

• The impact of automated scheduling alerts on the rate of followup to an outpatient provider within 14 days of hospital discharge.
• The impact of automated monitoring alerts on the prevalence of appropriate monitoring for selected high-risk medications within 45 days from the time of hospital discharge.
• The impact of a health information technology (IT)-based transitional care intervention on the incidence of ADEs within 45 days of hospital discharge.
• The impact of a health IT-based transitional care intervention on the rate of hospital readmissions and emergency department visits within 30 days of discharge.
• The costs directly related to the development and installation of the health IT-based transitional care intervention.

A randomized controlled trial of the transitional care intervention that included alerts about key therapeutic changes and monitoring recommendations and followup appointment reminders in a large multispecialty group practice was conducted. This intervention was tested in adults aged 65 and older who had been discharged from the hospital to the ambulatory setting. Randomization of the health IT-discharge communication occurred at the time of hospital discharge.

Significant improvements were not found in visits to the outpatient provider following discharge from the hospital, laboratory monitoring in response to alerts, ADE rates, or rehospitalization and ED visit rates relating to the intervention.