Virtual Continuity and Its Impact on Complex Hospitalized Patients' Care
Virtual Continuity and Its Impact on Complex Hospitalized Patients' Care
Communication between physicians caring for a patient in the hospital and that patient's
 primary care provider is less than optimal, and can lead to diminished health care quality
 and safety. This project will lead to better communication between physicians and could
 decrease medication errors that tend to occur as the patient goes from hospital to home.
Communication between physicians caring for hospitalized patients and those patients' primary
 care providers (PCPs) is often suboptimal. Hospital-based information systems can improve
 communication by automating information exchange between hospital physicians and PCPs, and
 perhaps, as a result, improve the quality and safety of health care. MedTrak, the University
 of Pittsburgh Medical Center (UPMC) electronic physician communication tool, has proven
 successful and is poised to move forward with an initiative the investigators call virtual
 continuity, allowing PCPs to follow their patients electronically if they cannot do so
 physically. Virtual continuity will include: emails to PCPs triggered by clinical events with
 embedded links to electronic medical record data and communication portals, medication lists
 electronically delivered to PCPs at admission and discharge, and immediate PCP notification
 of discharge with pertinent clinical details. To evaluate virtual continuity, the
 investigators will examine the frequency of discharge medication errors in complex medical
 patients using a pre-post study design of virtual continuity compared to usual communication.
 Medication errors will be ascertained using accepted methods. The investigators will also
 investigate differences in rehospitalization, post discharge emergency department visit and
 PCP follow up rates. The IT cost of implementing and maintaining the virtual continuity
 intervention will also be assessed. Virtual continuity will allow PCPs to participate more
 directly in the care of their hospitalized patients. Improved communication could lead to
 higher-quality patient care and greater patient care safety for hospitalized patients with
 complex medical problems.
Inclusion Criteria:

 -  Are admitted to UPMC Presbyterian General Medicine, Geriatrics, Cardiology, or Surgery
 inpatient services;

 -  Are 18 years of age or older;

 -  Are currently receiving 5 or more medications;

 -  Have 2 or more comorbid conditions present, defined using the Elixhauser comorbidity
 system (Med Care 1998;36:8-27 and Med Care. 2005 Nov; 43(11): 1130-9 ). These
 comorbidities are: congestive heart failure, cardiac arrhythmias, valvular disease,
 pulmonary circulation disorders, peripheral vascular disorders, hypertension,
 paralysis, other neurologic disorders, chronic pulmonary disease, diabetes
 uncomplicated, diabetes complicated, hypothyroidism, renal failure, liver disease,
 peptic ulcer disease excluding bleeding, AIDS/HIV disease, lymphoma, metastatic
 cancer, solid tumor without metastasis, rheumatoid arthritis/collagen vascular
 diseases, coagulopathy, obesity, weight loss, fluid and electrolyte disorders, blood
 loss anemia, deficiency anemias, alcohol abuse, drug abuse, psychoses, and depression

 -  Have a Primary Care Physician who has outpatient data included on EPIC electronic
 health record.

 Exclusion Criteria:

 -  Are admitted to critical care units;

 -  Are admitted from skilled nursing facilities;

 -  Have dementia;

 -  Were previously enrolled in the study

 -  Are organ transplant recipients