IMPACT-CI: Improving Medication Management Practices and Care Transitions through Technology—Focus on the Cognitively Impaired

Project Summary

To address the challenge of optimizing medication management for a particularly vulnerable population – community dwelling, cognitively impaired (CI) older adults with chronic illness and complex medication regimens. The project will implement and evaluate a multi-faceted, information technology (IT) based intervention designed to better support nurses, as well as cognitively impaired patients and their caregivers, in the challenging process of managing multiple medications in the context of multiple co-morbidities.

Technology

IT-based medication complexity algorithm, electronic clinical alerts and decision support tool, and caregiver support materials for CI elders with complex medications regimens.

Targeted Locations

4 Boroughs of New York City (NYC): Bronx, Brooklyn, Manhattan and Queens

Collaborators

• The Agency for Health Care Research and Quality (AHRQ) funded development of technology.
• Several VNSNY divisions will collaborate on this project.

12-Month Goals

• Successfully diffuse the medication management program utilizing PMD machines to four different provider types in four new geographic locations in California.
• Extend an IT intervention to improve management for CI patients in home health care with complex medication regimens
• Examine the effects of the intervention on medication management practices of intervention home health care nurses compared to usual care
• Examine the effects of the intervention on patient outcomes and service use

Older Adult Population

1st year: 150 (75 intervention, 75 usual care) CI patients.
5th year: Potential to apply intervention to 1200 CI patients/year in the VNSNY NYC service area and to 20% of home care clients in a target group of 1700 home care agencies nationwide.

Setting/Provider Type

Home health care and community-based health services

Measurable Outcomes

Comparison of intervention versus usual care nurse activities related to medication reconciliation, regimen simplification, caregiver teaching. Patient level outcomes include change in Medication complexity risk score, caregiver knowledge of and confidence in ability to manage medications and patient use of emergent services due to medication related events.

Replication, Dissemination Plan

VNSNY is well positioned to utilize several dissemination/marketing venues to expand technology use: 1) the national CHAMP program to advance excellence in home care for older people; 2) the national Home Health Quality Improvement Campaign, which has two main foci--improving medication management and avoiding unnecessary hospitalization; 3) AHRQ Innovations Exchange; and, 4) the National Association for Home Care.

Sustainability Plan

If proven successful, the automated complexity algorithm and electronic decision support tool can be instantly distributed (at no additional cost) to all VNSNY tablet computers. The technology can become part of the home nurses’ workflow. Other organizations will have free use of the algorithm, clinical alert content and tools.

Funding Request

$91,857

Matching Funds

$55,221