Domain | Specific aspect | MARQUIS1 | MARQUIS2 |
---|---|---|---|
Site Selection | How and when sites were recruited | Informal process, sites identified prior to submission of grant application | Widespread search, formal application process, most sites identified at beginning of study period |
Toolkit | Best possible medication history (BPMH) training | Didactic materials only, including slide presentations and videos | Didactic materials plus simulation materials with standardized cases and role-playing to enhance learning and verify competency |
Role of staff taking BPMH | Agnostic to type of personnel | Increased emphasis on the value of pharmacy technicians as “medication reconciliation assistants” trained to take accurate medication histories | |
Return on investment | Rudimentary calculations | More precise calculations based on MARQUIS1 data | |
Patient counseling tools | Didactic materials, including slide presentations and videos | Enhanced didactic materials plus scripts and worksheets developed with Patient and Family Advisory Council (PFAC) input | |
Implementation Approach | Site team training | Webinars | Webinars + 4 regional workshops |
Site visits, number and timing | 2 site visits: first visit in months 5–10, second in months 16–19 | 1 site visit within first 6 months | |
Patient-family engagement | No formalized program | Established and engaged PFAC in monthly discussions | |
Inter-site sharing | No formalized sharing | 3 peer-to-peer webinars featuring sites’ stories of successes and challenges | |
Health information technology (HIT) | Discovered significant challenges exist with the design, implementation, and use of HIT during medication reconciliation processes that, together with health systems issues, impacted medication safety | Provided guidance on how best to work with existing HIT—e.g. allowing pharmacists to make changes to medication lists, documenting the quality of the medication history taken and its sources, and customizing discharge instructions to make medication changes clear to patients and clinicians | |
Analyses | Intervention assessment | Scoring system of interventions; categorization of site-level intervention components based on meeting minutes analyzed retrospectively; no data on receipt of interventions at the patient level | Prospective collection of site-level interventions based on monthly site surveys; prospective collection of patient-level interventions as part of data collection on discrepancies |
Outcome assessment | Total medication discrepancies with potential for harm, involving adjudication; total medication discrepancies | Total medication discrepancies per medication per patient, as adopted by the Leapfrog Group [22] | |
Program evaluation | Surveys, direct observation, interviews, focus groups of contextual factors, intervention fidelity | RE-AIMa framework |