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Transitions in Care
Using Location-Based Smartphone Alerts Within a System of Care Coordination
This project will design and implement a care coordination system using a smartphone application that sends location-based alerts to care managers when high-risk patients receive care at a regional hospital or emergency room.
Using Social Knowledge Networking (SKN) Technology To Enable Meaningful Use of EHR Technology
This pilot project will implement a Social Knowledge Networking system to support progress toward “meaningful use” of medication reconciliation technology in an electronic health record.
Interactive Patient-Centered Discharge Toolkit To Promote Self-Management During Transitions
This project will implement and evaluate a previously developed, interactive, patient-centered discharge toolkit to improve the transition of care from the inpatient to outpatient settings.
Electronic Medication Adherence Reporting and Feedback During Care Transitions
This project will implement and evaluate a “smart” pillbox given to patients in order to understand its ability to minimize discrepancies in prescribed regimens and to improve patients’ medication adherence after hospital discharge.
Information Needs of Homecare Nurses During Admission and Care Planning
This project will analyze and model the information requirements, decisionmaking, and workflow of homecare nurses admitting patients and characterize if and how health information technology systems support their needs.
Developing an Interactive, Patient-Centered mHealth Tool to Enhance Post-Cystectomy Care
This project will develop a mobile health tool that will prospectively collect patient-centered outcomes data on key symptoms of postoperative bladder cancer patients.
Open & Act: Tracking Health Care Team Response to EHR Asynchronous Alerts
This project will analyze secondary data to identify factors associated with timely opening of electronic health record-based asynchronous alerts, timely response to the alerts, and patient outcomes.
Care Transitions and Teamwork in Pediatric Trauma: Implications for Health Information Technology Design
This project seeks to develop an understanding of the cognitive work of clinician teams and family members involved in pediatric trauma care transitions in order to design usable and useful health information technologies.
Understanding and Honoring Patients with Multiple Chronic Conditions
This project will determine care priorities for patients with multiple chronic conditions based on patient needs, preferences, and capabilities; and inform the design of a prototype interactive priority care plan shared between patients and providers.
Automated Notification for Follow-Up Testing Recommendations Across Care Settings
This project will build an automated intervention that will recognize critical imaging results that require followup testing and populate the discharge summary with followup testing recommendations.
