Computer Assisted Medication and Patient Information Interface (CAMPII) (Georgia)

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Summary:

Improvements in glucose control and other risk factors in diabetics have been shown to reduce diabetes complications and costs. Improving the flow of information between patients and their providers, particularly around medication adherence and information on adverse events, can improve the decisionmaking ability of clinicians in their care of these individuals. 

The Computer Assisted Medication and Patient Information Interface project (CAMPII) developed and tested “My Medication Helper” (MMH), an innovative computer assisted self-interview tool delivered via kiosk for use in a hospital diabetes clinic. MMH was designed for low-literacy diabetic patients to allow them to report both their current medications and hypoglycemic episodes, which are among the most common limiting adverse events for diabetics. These self-interviews take place prior to visits with providers to help improve the flow of relevant information to clinicians.   

Following development, MMH was evaluated with both crossover and randomized trials comparing the tool to traditional and customized paper instruments, the medical chart, and a comprehensive “gold standard” interview by a clinical pharmacist and certified diabetes educator.

The main objectives of this project were to:

  • Develop an accessible information computer interface in a municipal hospital diabetes clinic that patients can use to report medication information and adverse drug interactions. 
  • Develop a provider medication interface to support medication management functions. 
  • Assess the accuracy, acceptability, time efficiency, and utility of the information interface for both providers and patients.

The project successfully designed MMH with input from clinical and human factors experts and patients. The final tool had simple touch screen navigation, clear visual elements, voiceovers, and easy, non-judgmental questions. A provider interface was also developed to allow clinicians to reconcile patient-entered data and print medication instructions. 

In the study, the tool was found to be more accurate than traditional paper methods and compared favorably with the medical chart and comprehensive interview for medication accuracy. It was more sensitive in detecting hypoglycemia than all the comparison methods, although it had more false positives. Providers reported that the tool saved time and improved information quality. Study patients preferred the tool to paper forms. All methods were faster than the comprehensive interview. The project team concluded that use of the tool can improve care for patients with diabetes and improve provider accuracy and efficiency.

Computer Assisted Medication and Patient Information Interface - 2012

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Funding Mechanism: 
    RFA: HS08-269: Exploratory and Developmental Grant to Improve Health Care Quality Through Health Information Technology (R21)
  • Grant Number: 
    R21 HS 018236
  • Project Period: 
    December 2009 – September 2012
  • AHRQ Funding Amount: 
    $299,998
  • PDF Version: 
    (PDF, 275.54 KB)

Summary: Although many studies show that the complications and costs of diabetes can be reduced by controlling glucose and other risk factors, many people with diabetes do not achieve adequate control of these factors. Further, there is often a breakdown in information flow between patient and provider. Inadequate information from patients, particularly in the areas of medication adherence and associated adverse events, can lead providers to make poorly informed clinical decisions and provide inadequate or unclear instructions for patients. The goal of the Computer Assisted Medication and Patient Information Interface (CAMPII) project was to develop and test a tool to improve and standardize the flow of information between patients with type 2 diabetes and providers, thereby improving treatment outcomes and reducing complications.

The research team developed a touch-screen computer interface that low-literacy chronic disease patients at Grady Health System Diabetes Center, a municipal hospital specialty clinic, could use to report medication information, hypoglycemic events, and adverse drug interactions. Patients accessed the interface through a computer kiosk called My Medication Helper (MMH), which is designed to collect complete and accurate information. This information was provided to clinicians so they could make more-informed therapeutic decisions for their diabetic patients. A pilot study of the patient interface was designed to inform methods and additional data elements for a full interface evaluation, and findings were also used to improve usability of the interface. A crossover study was conducted with 117 pilot subjects who completed medication, adherence, and hypoglycemia surveys using MMH; completed two paper surveys; and had an interview with a pharmacist regarding their medication use.

A full evaluation of the patient interface used a randomized trial of 239 subjects, 221 of whom completed the intervention. The trial compared the completeness and accuracy of CAMPII to traditional and customized paper instruments, patient medical charts, and the reference-standard of a comprehensive multi-source interview by an experienced pharmacy expert. The research team also assessed the accuracy, acceptability, efficiency, and utility of the patient information interface for both providers and patients.

A provider medication interface was developed based on interviews, testing, and feedback from providers including nurses, endocrinologists, and pharmacists. The purpose of this interface was to support medication management functions, including medication reconciliation (e.g., correcting incoming medication data, entering new drug regimens), and printing of medication instructions and a daily medication schedule that the patient could take home after each visit.

Specific Aims:

  • Develop an accessible information computer interface in a municipal hospital diabetes clinic that patients can use to report medication information and adverse drug interactions. (Achieved)
  • Develop a provider medication interface to support medication management functions. (Achieved)
  • Assess the accuracy, acceptability, efficiency, and utility of the information interface for both providers and patients. (Achieved)

2012 Activities: Dr. Ziemer and his team focused on data quality review and data management activities, review of outcomes, identification of key questions, development of pilot projects to clarify hypoglycemia screening and cross-discipline reliability of adverse events, planning for final publications and reporting, and planning (i.e., grant applications) to advance the project.

As last reported in the AHRQ Research Reporting System, project progress was on track and budget spending was on target. The grant ended in September 2012.

Impact and Findings: Analyses of final data sets are ongoing. Final reviews will focus on assessment of the accuracy, acceptability, efficiency, and utility of the patient information interface for both providers and patients.

In terms of process findings, the research team found that CAMPII was more accurate than traditional paper methods, and compared favorably with both the medical chart and comprehensive interview for medication accuracy. CAMPII was more sensitive for hypoglycemia than all other methods, including the medical chart, with a somewhat higher rate of false positives.

Use of the MMH computer kiosk to acquire medication history was preferred by patients, despite lower rates of familiarity with computers and the fact that it took longer than the paper forms. Although 53 percent of the subjects reported rarely or never having used a computer, 79 percent reported that MMH was easier to use than the paper forms, and 89 percent felt that MMH was more helpful in recalling their medications. Providers felt CAMPII saved time and improved information quality.

Target Population: Adults, Chronic Care*, Diabetes, Racial or Ethnic Minorities*: African-American

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve the quality and safety of medication management via the integration and utilization of medication management systems and technologies.

Business Goal: Knowledge Creation

* This target population is one of AHRQ’s priority populations.

Computer Assisted Medication and Patient Information Interface (CAMPII) - 2011

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Funding Mechanism: 
    RFA: HS08-269: Exploratory and Developmental Grant to Improve Health Care Quality Through Health Information Technology (R21)
  • Grant Number: 
    R21 HS 018236
  • Project Period: 
    December 2009 - September 2012
  • AHRQ Funding Amount: 
    $299,998
  • PDF Version: 
    (PDF, 194.3 KB)

Summary: Although many studies show that the complications and costs of diabetes can be reduced by controlling glucose and other risk factors, many people with diabetes do not achieve good control of these factors. Further, there is often a breakdown in information flow between patient and provider. Inadequate information from patients, particularly in the areas of medication adherence and associated adverse events, can lead providers to make poorly-informed clinical decisions and provide inadequate or unclear instructions for patients. The goal of this Computer Assisted Medication and Patient Information Interface (CAMPII) project is to develop and test a tool to improve and standardize the flow of information between patients with type 2 diabetes and providers, thereby improving treatment outcomes and reducing complications.

The research team developed a touch-screen computer interface that patients at Grady Health System Diabetes Center, a municipal hospital specialty clinic, can use in to report medication information and adverse drug interactions, including hypoglycemia. The patient information interface is designed to collect complete and accurate information so providers can make informed therapeutic decisions for their patients who have diabetes and the associated major cardiovascular risk factors.

A provider medication interface was developed to improve the clarity and accuracy of the information received by providers and the quality of information shared with patients and other providers, with a particular focus on providing clear, detailed instructions, and motivational information to patients. The provider interface is designed to support medication management functions, including medication reconciliation, printing of medication instructions, and production of a daily medication schedule for patients.

A full interface evaluation will compare the completeness and accuracy of medication information obtained by traditional and computer-assisted methods with the reference-standard of a comprehensive multi-source interview by an experienced pharmacy expert. The research team will also assess the accuracy, acceptability, efficiency, and utility of the patient information interface for both providers and patients in a study population of type 2 diabetes patients.

Specific Aims:

  • Develop an accessible information computer interface in a municipal hospital diabetes clinic that patients can use to report medication information and adverse drug interactions. (Achieved)
  • Develop a provider medication interface to support medication management functions. (Achieved)
  • Assess the accuracy, acceptability, time efficiency, and utility of the information interface for both providers and patients. (Ongoing)

2011 Activities: Design of the provider medication interface was completed in spring 2011. The patient interface was completed in September 2010 and enhanced in June 2011 before the randomized trial. The patient interface is designed for a full size touch-screen PC with a 20-inch monitor. Patients touch large onscreen buttons and thus there are only minimal dexterity and hand-eye coordination requirements for users. Voice-over instructions and reading of options minimize literacy requirements.

Data collection was completed in fall 2011, at which time Dr. Ziemer began work on data analysis, synthesis, and reporting. This includes data quality and data management activities, review of outcomes and identification of key questions, and planning for final publications and reporting.

A total of 239 subjects were recruited, 221 of whom completed the intervention. While the original study plan called for 75 study subjects, some new questions were added to the patient interface and the protocol was modified to allow focused testing of hypoglycemia questions, which required additional subjects to provide the necessary evidence and power for review. These changes were adopted with intuitional review board approval. Through followup phone interviews, the research team asked patients a few additional questions about their medication list. Medication lists were printed for patients enrolled in the computerized portion of the study, while patients enrolled in the paper-only portion were given paper so that they could write the information. Patients enrolled in the usual care portion were not involved in either process. Between 2 and 6 weeks later, team members asked patients in the computerized and paper-only portions to try to find their medication lists and to confirm one or two of the medicines on the list.

As last self-reported in the AHRQ Research Reporting System, project progress and activities are on track and spending is roughly on target. Due to initial staffing challenges related to timing of the grant start date, the project team is using a 10-month no-cost extension to support data analysis and reporting of trial data.

Preliminary Impact and Findings: Preliminary data strongly suggest that the touch-screen CAMPII method is more sensitive for detecting and recording hypoglycemia than provider documentation in the medical chart or patient documentation on the paper forms. CAMPII is also better than the chart or standard forms for identifying associated adverse events.

CAMPII computer-assisted self-interview is better for detecting hypoglycemia than chart documentation, is more specific than paper forms, and, from the provider perspective, was also a more efficient tool than usual care.

Target Population: Adults, Chronic Care*, Diabetes, Racial or Ethnic Minorities*: African-American

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve the quality and safety of medication management viathe integration and utilization of medication management systems and technologies.

Business Goal: Knowledge Creation

* This target population is one of AHRQ's priority populations.

Computer Assisted Medication and Patient Information Interface (CAMPII) - 2010

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Funding Mechanism: 
    RFA: HS08-269: Exploratory and Developmental Grant to Improve Health Care Quality Through Health Information Technology (R21)
  • Grant Number: 
    R21 HS 018236
  • Project Period: 
    December 2009 – November 2011
  • AHRQ Funding Amount: 
    $299,998
  • PDF Version: 
    (PDF, 354.28 KB)


Target Population: Adults, Chronic Care*, Diabetes, Racial or Ethnic Minorities*: African American

Summary: Although many studies show that the complications and costs of diabetes can be reduced by controlling glucose and other risk factors, many persons with diabetes do not achieve good control of these factors. Data suggest that there is often a breakdown in information flow between patient and provider. Inadequate information from patients, particularly in the areas of medication adherence and associated adverse events, can lead to poorly-informed clinical decisionmaking and inadequate or unclear instructions for patients. The goal of this Computer Assisted Medication and Patient Information Interface (CAMPII) project is to develop and test a tool to improve and standardize the flow of information between patients with type 2 diabetes and providers, thereby improving treatment outcomes and reducing complications.

The research team is developing an accessible touch-screen computer interface that patients can use in a municipal hospital diabetes clinic to report medication information and adverse drug interactions, including hypoglycemia. The patient information interface will obtain complete and accurate information from patients so that providers can make informed therapeutic decisions for patients with diabetes and its major cardiovascular risk factors.

A provider medication interface will be developed to improve the clarity and accuracy of the information received by providers and the quality of information shared with patients and other providers, with a particular focus on providing clear, detailed instructions and motivational information to patients. The provider interface will support medication management functions, including correcting incoming medication data, entry of new drug regimens, printing of medication instructions, and production of a daily medication schedule for patients.

A full interface evaluation will compare the completeness and accuracy of medication information obtained by traditional and computer-assisted methods against the reference standard of comprehensive multi-source interview by an experienced pharmacy expert. The team will also assess the accuracy, acceptability, time efficiency, and utility of the patient information interface for both providers and patients in a study population of type 2 diabetes patients with at least two visits in the prior year.

Specific Aims:
  • Develop an accessible information computer interface in a municipal hospital diabetes clinic that patients can use to report medication information and adverse drug interactions. (Ongoing)
  • Develop a provider medication interface to support medication management functions. (Ongoing)
  • Assess the accuracy, acceptability, time efficiency, and utility of the information interface for both providers and patients. (Upcoming)

2010 Activities: By the end of 2010, a total of 79 participants (19 development and 60 pilot subjects) were enrolled to test the patient interface. Each subject was to complete a CAMPII information entry session with the touch-screen interface; a one-page medication form promoted by the American Public Health Association; and a six-page checklist style form, tailored to list the clinic's usual medications and containing hypoglycemia questions. In addition, for the 60 pilot subjects there was an interview with a pharmacist who assessed the “truth” (whether the patient has actually been taking the medication); as well as surveys about the forms and CAMPII. Session data were collected, including process details for the CAMPII-patient interaction (e.g. duration of session, number of steps, seconds per screen, etc); along with medication, hypoglycemia, and other information entered by patients on the computer kiosk. Data were coded and entered into a database to allow comparison of the patient information sources to the "truth." Multiple scoring methods were applied. These will inform methods for the full interface evaluation and identify additional data elements needed. Preliminary results will be reported in 2011.

Dr. Ziemer and his team are in the process of developing the provider medication interface to enable provider correction of incoming medication data, entry of new drug regimens, and printing of prescriptions and medication instructions. Providers will be able to update a daily medication schedule for the patient that includes pill pictures, medication purpose, expected benefits, and potential adverse reactions.

The planned full interface evaluation will include an assessment of the accuracy, acceptability, time efficiency, and utility of the patient information interface for both providers and patients. During 2010, the team conducted team meetings to finalize processes, forms, and interface elements for this evaluation.

Grantee's Most Recent Self-Reported Quarterly Status (as of December 2010): Project progress is mostly on track. The project budget is significantly underspent (more than 20 percent) because of early staffing challenges related to timing of the grant start date.

Preliminary Impact and Findings: The preliminary data strongly suggest that the touch-screen CAMPII method is more sensitive for detecting and recording hypoglycemia than the medical chart or the paper forms. Scoring methods have not been finalized but some of the scores suggest that CAMPII is better than standard paper forms, but somewhat worse than the medical chart for reporting medication adherence. CAMPII is better than the chart or standard forms for identifying associated adverse events.

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve the quality and safety of medication management via the integration and utilization of medication management systems and technologies.

Business Goal: Knowledge Creation

*AHRQ Priority Population.

Computer Assisted Medication and Patient Information Interface (CAMPII) - Final Report

Citation:
Ziemer, D. Computer Assisted Medication and Patient Information Interface (CAMPII) (Georgia) - Final Report. (Prepared by Emory University under Grant No. R21 HS018236 ). Rockville, MD: Agency for Healthcare Research and Quality, 2012. (PDF, 936.15 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. 
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