The Medication Metronome Project - Study to Facilitate Follow-up Testing Resulting From Prescribed Medications to Improve Patient Safety and Care
| Status: | Completed |
|---|---|
| Conditions: | High Blood Pressure (Hypertension), High Cholesterol, Diabetes |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Endocrinology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/21/2016 |
| Start Date: | May 2012 |
| End Date: | May 2013 |
The Medication Metronome Project
This project tests a model of chronic disease medication management in which the decision to
initiate or adjust medical therapy is directly linked to a sequence of subsequent clinical
actions (e.g. monitoring for adverse drug events, assessing response to therapy, changing
medication dose) performed independently of the office visit. The investigators hypothesize
that establishing a visit-independent, health information technology (IT) supported cycle of
laboratory monitoring and iterative medication dose adjustment will result in more effective
chronic disease care.
initiate or adjust medical therapy is directly linked to a sequence of subsequent clinical
actions (e.g. monitoring for adverse drug events, assessing response to therapy, changing
medication dose) performed independently of the office visit. The investigators hypothesize
that establishing a visit-independent, health information technology (IT) supported cycle of
laboratory monitoring and iterative medication dose adjustment will result in more effective
chronic disease care.
To implement a new model of chronic disease management, we will build on our existing
electronic health record and integrated data systems to develop an advanced health IT
application called the "Medication Metronome" to enable providers to schedule future
laboratory tests related to a specific set of medications (for glycemic, cholesterol, and
blood pressure management). As these lab test dates become due, the Medication Metronome
system will remind patients via letter and inform providers when the tests remain "missing."
The goal of this intervention is to implement an efficient, visit-independent system to
ensure that patients are rapidly and safely brought to evidence-based treatment goals and to
prevent delays in planned laboratory monitoring. This study has the following aims:
Aim 1: To develop the Medication Metronome system. This work involves health IT development
and evaluation of design prototypes to create a system that supports timely medication
intensification, improves safety, and meets both patient and provider needs.
Aim 2: To conduct a randomized controlled trial of the Medication Metronome system. We will
use three target chronic conditions to test different elements of the system. We hypothesize
that use of the Medication Metronome system will lead to:
H2a. More effective HbA1c control among patients with type 2 diabetes prescribed
hypoglycemic medicines; H2b. Safer medication management among patients with hypertension
prescribed thiazide diuretics, angiotensin converting enzyme inhibitors, or angiotensin II
receptor blockers; H2c. Both more effective LDL-cholesterol control and safer monitoring for
hepatitis among patients with hyperlipidemia prescribed HMG-CoA reductase inhibitors.
Aim 3: To evaluate the impact of the Medication Metronome visit-independent care model on
the content of office-based visits. Time spent addressing different clinical care domains
will be assessed using audiotape-based content analysis in a subset of selected office
visits.
Summary: We will implement, and rigorously evaluate a health IT-supported model of
visit-independent medication management designed to enable safer and more effective chronic
disease care. We will also carefully investigate the impact of this system on primary care
visits. The broader goal of this work is to support health delivery redesign that fosters
patient-centered primary care by combining visit-independent medication management with more
productive visit-based patient-provider interactions.
electronic health record and integrated data systems to develop an advanced health IT
application called the "Medication Metronome" to enable providers to schedule future
laboratory tests related to a specific set of medications (for glycemic, cholesterol, and
blood pressure management). As these lab test dates become due, the Medication Metronome
system will remind patients via letter and inform providers when the tests remain "missing."
The goal of this intervention is to implement an efficient, visit-independent system to
ensure that patients are rapidly and safely brought to evidence-based treatment goals and to
prevent delays in planned laboratory monitoring. This study has the following aims:
Aim 1: To develop the Medication Metronome system. This work involves health IT development
and evaluation of design prototypes to create a system that supports timely medication
intensification, improves safety, and meets both patient and provider needs.
Aim 2: To conduct a randomized controlled trial of the Medication Metronome system. We will
use three target chronic conditions to test different elements of the system. We hypothesize
that use of the Medication Metronome system will lead to:
H2a. More effective HbA1c control among patients with type 2 diabetes prescribed
hypoglycemic medicines; H2b. Safer medication management among patients with hypertension
prescribed thiazide diuretics, angiotensin converting enzyme inhibitors, or angiotensin II
receptor blockers; H2c. Both more effective LDL-cholesterol control and safer monitoring for
hepatitis among patients with hyperlipidemia prescribed HMG-CoA reductase inhibitors.
Aim 3: To evaluate the impact of the Medication Metronome visit-independent care model on
the content of office-based visits. Time spent addressing different clinical care domains
will be assessed using audiotape-based content analysis in a subset of selected office
visits.
Summary: We will implement, and rigorously evaluate a health IT-supported model of
visit-independent medication management designed to enable safer and more effective chronic
disease care. We will also carefully investigate the impact of this system on primary care
visits. The broader goal of this work is to support health delivery redesign that fosters
patient-centered primary care by combining visit-independent medication management with more
productive visit-based patient-provider interactions.
Inclusion Criteria:
- All primary care physicians from participating practices will be eligible to
participate in the study.
- Patients Eligible for Analysis: The primary unit of analysis will be prescribed
medicine, grouped with patient and within prescribing PCP. Three potentially
overlapping medication-based cohorts will be defined: 1) Patients prescribed any
hypoglycemic agents, 2) Patients prescribed thiazide diuretics, ACE-Is, or ARBs,
and 3) Patients prescribed statins. Based on this design, individual patients
may contribute to more than one medication analytic cohort.
Exclusion Criteria:
- Patients Excluded from Analysis: Patients who are subsequently identified as having
died during the course of the study intervention using the Social Security Death
Index, to have left the MGH system, or to have changed PCPs.
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