Approximately 50% of patients in U.S. hospitals experience at least 1 unintentional medication discrepancy
and 52% of these discrepancies have the potential for significant harm. Medication reconciliation (MedRec)
can reduce the number of medication discrepancies by more than 60%. However, the complexity and
contextual barriers associated with MedRec have stunted implementation, and best practices to foster effective
implementation and sustainability remain largely unknown.
Published MedRec studies usually have an inadequate description of the implementation methods and the
contextual factors driving their selection. A lack of both long-term outcome studies and valid measures of
sustainability have further limited our understanding of how to best sustain effective MedRec interventions.
Identifying how implementation strategies and contextual factors (i.e., capacity, leadership, goal alignment,
climate, readiness for change, and team cohesion) predict sustainability and long-term effectiveness of
MedRec interventions, would provide important guidance for hospitals nationally and improve patient safety.
This proposal describes a career development plan that enables the candidate to gain expertise in
advanced research methods and implementation science, through mentored research and didactic training. It
leverages the AHRQ-funded, “Implementation of a Medication Reconciliation Protocol to Improve Patient
Safety,” study (MARQUIS2, R18 HS023757), which is investigating MedRec in 18 diverse U.S. hospitals, and
provides a unique opportunity to study organizational context and sustainability at these facilities. The Specific
Aims are: 1) Describe implementation strategies and examine their association with contextual factors; 2)
Develop and validate a sustainability measure; and, 3) Investigate the relationship of contextual factors and
implementation strategies with the sustainability of MedRec interventions.
The candidate is highly qualified as a PhD prepared nurse who has studied sustainability in other contexts.
The career development plan builds on this foundation to provide: a) advanced skills in research methods
(e.g., focus groups and multi-level modeling), implementation science, and instrument development; b)
scientific writing skills through manuscript preparation and grant writing; and, c) an interdisciplinary mentored
research experience with experts in implementation research. The institutional environment is exceptional,
including research centers in implementation research and qualitative methods.
This career development award will allow the candidate to develop a deep understanding of
implementation methods and expertise in measurement to study the sustainability of complex, interdisciplinary
interventions in healthcare organizations. This award will position the candidate to become an R01-funded
independent investigator who develops evidence-based implementation practices for optimizing the
sustainability of complex healthcare interventions to improve patient safety and quality of care.