The Remington Report

The Visiting Nurse Service of New York (VNSNY) Center for Home Health Care Policy & Research 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.

One of the most frequent risk factors leading to unplanned hospitalizations and emergency department visits is poor medication management. Frequently, patients cared for at home combine the two conditions that exacerbate the risk: some level of functional impairment and multiple prescriptions.

According to the VNSNY, half of home care patients require assistance in administering their medications and half show some level of functional impairment. The average home care patient takes six to eight medications; 20% take nine or more.

The project will implement and evaluate a multi-faceted, 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 conditions. 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 will be known as IMPACT-CI (Improving Medication Management Practices and Care Transitions through Technology – Focus on the Cognitively Impaired). VNSNY nurses will use existing computer modules, housed on special tablet computers, 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.

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.