This study sought to determine the effects of automated primary care physician (PCP) communication and patient safety tools, including computerized discharge medication reconciliation, on discharge medication errors and posthospitalization patient outcomes, using a pre-post quasi-experimental study design, in hospitalized medical patients with ≥2 comorbidities and ≥5 chronic medications, at a single center. The primary outcome was discharge medication errors, compared before and after rollout of these tools. Secondary outcomes were 30-day rehospitalization, emergency department visit, and PCP follow-up visit rates. This study found that discharge medication errors were lower post intervention (odds ratio = 0.57; 95% confidence interval = 0.44-0.74; P < .001). Clinically important errors, with the potential for serious or life-threatening harm, and 30-day patient outcomes were not significantly different between study periods. Thus, automated health system–based communication and patient safety tools, including computerized discharge medication reconciliation, decreased hospital discharge medication errors in medically complex patients.
WachterRMGoldmanL. The hospitalist movement 5 years later. JAMA. 2002;287:487-494.
2.
JungerwirthRWheelerSBPaulJE. Association of hospitalist presence and hospital-level outcome measures among medicare patients. J Hosp Med. 2014;9:1-6.
3.
GoldmanLPantilatSZWhitcombWF. Passing the clinical baton: 6 principles to guide the hospitalist. Am J Med. 2001;111:36S-39S.
4.
HalasyamaniLKripalaniSColemanE. Transition of care for hospitalized elderly patients–development of a discharge checklist for hospitalists. J Hosp Med. 2006;1:354-360.
5.
KripalaniSJacksonATSchnipperJLColemanEA. Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists. J Hosp Med. 2007;2:314-323.
6.
KripalaniSLeFevreFPhillipsCOWilliamsMVBasaviahPBakerDW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007;297:831-841.
7.
AuerbachADNelsonEALindenauerPKPantilatSZKatzPPWachterRM. Physician attitudes toward and prevalence of the hospitalist model of care: results of a national survey. Am J Med. 2000;109:648-653.
8.
PantilatSZLindenauerPKKatzPPWachterRM. Primary care physician attitudes regarding communication with hospitalists. Am J Med. 2001;111:15S-20S.
9.
RoyCLPoonEGKarsonAS. Patient safety concerns arising from test results that return after hospital discharge. Ann Intern Med. 2005;143:121-128.
10.
MooreCWisniveskyJWilliamsSMcGinnT. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med. 2003;18:646-651.
11.
ForsterAJMurffHJPetersonJFGandhiTKBatesDW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138:161-167.
12.
ForsterAJMurffHJPetersonJFGandhiTKBatesDW. Adverse drug events occurring following hospital discharge. J Gen Intern Med. 2005;20:317-323.
13.
GreenwaldJLDenhamCJackB. The hospital discharge: a review of a high risk care transition with highlights of a reengineered discharge process. J Patient Saf. 2007;3:97-106.
14.
SchnipperJLKirwinJLCotugnoMC. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006;166:565-571.
GreenwaldJLHalasyamaniLGreeneJ. Making inpatient medication reconciliation patient centered, clinically relevant and implementable: a consensus statement on key principles and necessary first steps. J Hosp Med. 2010;5:477-485.
18.
HesselinkGSchoonhovenLBarachP. Improving patient handovers from hospital to primary care: a systematic review. Ann Intern Med. 2012;157:417-428.
19.
EgginkRNLenderinkAWWiddershovenJWvan den BemtPM. The effect of a clinical pharmacist discharge service on medication discrepancies in patients with heart failure. Pharm World Sci. 2010;32:759-766.
20.
KripalaniSRoumieCLDalalAK. Effect of a pharmacist intervention on clinically important medication errors after hospital discharge: a randomized trial. Ann Intern Med. 2012;157:1-10.
21.
SchnipperJLLiangCLHamannC. Development of a tool within the electronic medical record to facilitate medication reconciliation after hospital discharge. J Am Med Inform Assoc. 2011;18:309-313.
22.
SchnipperJLHamannCNdumeleCD. Effect of an electronic medication reconciliation application and process redesign on potential adverse drug events: a cluster-randomized trial. Arch Intern Med. 2009;169:771-780.
SmithKJClarkSKapoorWNHandlerSM. Information primary care physicians want to receive about their hospitalized patients. Fam Med. 2012;44:425-430.
25.
ElixhauserASteinerCHarrisDRCoffeyRM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8-27.
26.
ViraTColquhounMEtchellsE. Reconcilable differences: correcting medication errors at hospital admission and discharge. Qual Saf Health Care. 2006;15:122-126.
27.
PippinsJRGandhiTKHamannC. Classifying and predicting errors of inpatient medication reconciliation. J Gen Intern Med. 2008;23:1414-1422.
28.
HosmerDWLemeshowSSturdivantRX. Applied Logistic Regression. 3rd ed.New York, NY: Wiley; 2013.
29.
van WalravenCAustinPCJenningsAQuanHForsterAJ. A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data. Med Care. 2009;47:626-633.
30.
ColemanEABoultC. Improving the quality of transitional care for persons with complex care needs. J Am Geriatr Soc. 2003;51:556-557.
31.
LeeRGGarvinT. Moving from information transfer to information exchange in health and health care. Soc Sci Med. 2003;56:449-464.
32.
SalanitroAHKripalaniSResnicJ. Rationale and design of the Multicenter Medication Reconciliation Quality Improvement Study (MARQUIS). BMC Health Serv Res. 2013;13:230.
33.
Garcia-AparicioJHerrero-HerreroJI. Medication errors detected in elderly patients admitted to an internal medicine service. Int J Clin Pract. 2013;67:282-289.
34.
HandlerSMAltmanRLPereraS. A systematic review of the performance characteristics of clinical event monitor signals used to detect adverse drug events in the hospital setting. J Am Med Inform Assoc. 2007;14:451-458.
35.
HarrisADMcGregorJCPerencevichEN. The use and interpretation of quasi-experimental studies in medical informatics. J Am Med Inform Assoc. 2006;13:16-23.
