Identification and Prevention of Potentially Inappropriate Inter-Hospital Transfers

Identification and Prevention of Potentially Inappropriate Inter-Hospital Transfers - Aims 2 and 3 Study Fact Sheet for Adjudication Participation Principal Investigator: Stephanie K. Mueller, MD, MPH Purpose and Background: Thank you for participating in this study. In this research study, Aim 2 will identify and determine the incidence of potentially inappropriate inter-hospital transfers and estimate their patient safety impact among hospitalized medical patients using a standardized adjudication process of patients transferred to 18 hospitals affiliated with Hospital Medicine Reengineering Network (HOMERuN). HOMERuN was established in 2011 to advance the field of Hospital Medicine by supporting and conducting rigorous, multi-center research studies to improve the care of patients with acute illnesses, with a focus on improving transitions of care period. Aim 3 of the study, in conjunction with, and following, Aim 2, will (A) combine adjudication data from HOMERuN sites with data from Vizient to retrospectively characterize a population of potentially inappropriate inter-hospital transfers; and (B) derive and validate a model to prospectively identify potentially inappropriate inter-hospital transfers. Vizient is a health care services company dedicated to providing innovative data-driven solutions, expertise and collaborative opportunities that lead to improved patient outcomes and lower costs. Aims 2 and 3 will build upon the stakeholder input (including patients and families, clinicians from transferring and receiving hospitals, and hospital leadership) to define potentially inappropriate inter-hospital transfers determined through focus group sessions completed in Aim 1 (Protocol Number 2022P002158). For the purposes of this study, based on the results from Aim 1, existing adjudication tools will be modified, finalized, and deployed to the 18 sites to conduct targeted medical record review. Potential cases for adjudication will be identified using Vizient data from participating sites. The adjudication process will involve rigorous training and support to carry out reliable adjudication of 1800 IHT cases (100 cases per site). This study is funded through the Agency for Healthcare Research and Quality (AHRQ). We obtained your name and contact information because you are a key member of the care team involved during inter-hospital transfer and think that your participation will be important in helping to quantify the incidence and patient safety impact of potentially inappropriate transfers. Participation and Methods: You are being asked to participate in Aims 2 and 3 as a reviewer to conduct approximately 100 targeted medical record reviews (about 10-12 cases per month) from your site. Prior to starting adjudications, we will hold a (virtual) meeting of site leads and co-investigators to review tools, carry out adjudication of sample cases as a group and then in pairs, and provide ongoing guidance on conducting effective and accurate adjudications throughout the adjudication process. Your participation in these research activities is completely voluntary. Deciding not to participate won’t affect your professional standing or evaluations in the unit or department. If you do choose to participate, you may discontinue participation at any time without penalty. Compensation: You will be compensated for your time as a reviewer ($40 for each case you review). Risks, Benefits, & Confidentiality: Aims 2 and 3 of the study are considered to be minimal risk, as you will only be interacting with patient data within the chart, not with patients directly. During the case review, the patient cases that will be included from each site will be generated from Vizient (all included sites have a data use agreement with Vizient already); reviewers will be doing chart adjudications on these patients. Vizient will only provide patient case data to the site where the patient was seen – none of the 18 sites will have access to another site’s patient data, and site identifiers will only be known by Vizient, the site, and the primary IRB-approved research team. All final data reporting will be presented in aggregate and site deidentified. Risks related to reviewer activities include the inconvenience of participating in trainings, reviews, and survey completion. Given the low risk conducting patient chart reviews and to the reviewers and the measures that will be taken to minimize these risks, we believe these risks are reasonable in relation to these potential benefits. We will handle protection against breach of confidentiality in several ways. First, data collection will follow established procedures in full compliance with HIPAA regulations. Only IRB-approved study staff will have access to clinician and patient identifiers. Second, data will be stored in a password-protected database on a password-protected computer/platform (i.e., REDCap) behind the MGB firewall. Third, no data will be collected on paper. Finally, data will be analyzed and presented in aggregate. These steps are likely to be very effective in protecting confidentiality. Inconvenience of participation by the participating site reviewers will be minimized through the opt-out process and the voluntary nature of the data collection process. Some benefits of participating include, but are not limited to, training on this review process, and the opportunity to network with hospital medicine researchers at BWH and other institutions. We believe future patients, clinicians and hospital systems are likely to benefit by the knowledge gained by this study – a greater understanding and defining of potentially inappropriate IHT among hospitalized medical patients will help identify patients exposed to the risks of IHT. Questions or Concerns: If you have any questions or would like more information about this study, please feel free to contact: Stephanie Mueller, MD, MPH, Principal Investigator 617-278-0628 [email protected] This research has been reviewed by the Mass General Brigham Institutional Review Board. If you wish to speak to someone not involved in this research about your rights as a research subject, or any concerns or complaints you may have about the research, contact the MGB Human Research Committee at 857-282-1900.