VNSNY receives funding for testing IT strategies to aid elderly cognitive impairment patients

The Center for Technology and Aging Helps VNSNY Harness the Power of the Electronic Health Record and Test Cutting-Edge Solutions to Dangerous Medication-Related Problems

The Visiting Nurse Service of New York (VNSNY) Center for Home Health Care Policy & Research, the only research center focused on studying home health care in the U.S., has received funding from The Center for Technology and Aging to test state-of-the art information technology (IT) strategies designed to help elderly patients with cognitive impairment and their caregivers safely manage multiple medications.

Half of home care patients require assistance in administering their medications and half of home care patients have some level of functional impairment. The average home care patient takes six to eight medications, with 20 percent taking nine or more. Poor medication management has been identified as one of the most frequent risk factors leading to unplanned hospitalizations and emergency room visits.

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 patients with multiple chronic illnesses. The study will introduce automated clinical alerts and educational tactics for home care nurses and family caregivers who are supervising long-term medication management of cognitively impaired at-risk seniors.

"Cognitive impairment in relation to adverse drug events is seriously under-studied, and for older patients with complex chronic illnesses, that could mean preventable emergency department visits," said Penny Hollander Feldman, Ph.D., principal investigator of the study and director of VNSNY's Center for Home Care Policy and Research. "The new technology being funded in this project provides our home care nurses with cutting edge tools to help keep patients safer and improve management and adherence to complicated medication regimens. In addition, this funding is particularly meaningful because it lays the foundation for a nationwide rollout of these tools as the study continues."

The randomized, controlled trial, known as IMPACT-CI (Improving Medication Management Practices and Care Transitions through Technology -- Focus on the Cognitively Impaired), uses existing computer modules housed on special tablet computers carried by all VNSNY nurses, to identify patients at risk of a potentially serious medication problem and help nurses efficiently direct their time and energy.  By integrating a computer algorithm into the VNSNY IT system, a medication regimen complexity index (MRCI) score for each patient takes into account dosing frequency, delivery (orally, inhalant, injection) and special instructions such as "take with meals," "dissolve," or "take on alternate days."  This MRCI score allows for a highly nuanced indicator of complexity and potential for adverse effects.

Additionally, a decision support tool has been integrated into the nurses' tablet systems, providing guidance for a thorough medication reconciliation and medication adherence assessment, along with strategies for communicating with the patient's primary care physician in an effort to simplify the regimen.

"With this project, VNSNY and the Center for Home Care Policy & Research will be demonstrating how an important technology can make a significant difference in the quality of life for older adults who rely on medications to manage chronic conditions," said David Lindeman, Ph.D., director of the Center for Technology and Aging.  "This project will help speed the adoption of important technologies across the country."

The Center for Technology and Aging medication optimization diffusion grants program is designed to expand use of technologies that help improve medication use in older adults with chronic health conditions. A detailed summary of projects and the Medication Optimization Position Paper are available on the Center's Web site (www.techandaging.org).

"Proven, cost-effective information and communication strategies to improve medication management in the home health care setting are sorely lacking," said Dr. Feldman. "Findings from the IMPACT-CI study will accelerate progress toward filling a critical knowledge gap and help us introduce new and better measures for preventing medication-related adverse events."

This initiative allows the Center to leverage a three-year IMPACT study that has been made possible with a $1.2 million grant from the Agency for Health Care Research and Quality (AHRQ), a federal agency committed to helping the nation improve its health care system, by expanding the scope to include the cognitively impaired population and their caregivers.  The study is being conducted through the Visiting Nurse Service of New York, the largest not-for-profit home care organization in the United States.