RESUMO
Water utilities are vulnerable to a wide variety of human-caused and natural disasters. The Water Network Tool for Resilience (WNTR) is a new open source Python™ package designed to help water utilities investigate resilience of water distribution systems to hazards and evaluate resilience-enhancing actions. In this paper, the WNTR modeling framework is presented and a case study is described that uses WNTR to simulate the effects of an earthquake on a water distribution system. The case study illustrates that the severity of damage is not only a function of system integrity and earthquake magnitude, but also of the available resources and repair strategies used to return the system to normal operating conditions. While earthquakes are particularly concerning since buried water distribution pipelines are highly susceptible to damage, the software framework can be applied to other types of hazards, including power outages and contamination incidents.
RESUMO
BACKGROUND: Older adults commonly face challenges in understanding, obtaining, administering, and monitoring medication regimens after hospitalization. These difficulties can lead to avoidable morbidity, mortality, and hospital readmissions. Pharmacist-led peri-discharge interventions can reduce adverse drug events, but few large randomized trials have examined their effectiveness in reducing readmissions. Demonstrating reductions in 30-day readmissions can make a financial case for implementing pharmacist-led programs across hospitals. METHODS/DESIGN: The PHARMacist Discharge Care, or the PHARM-DC intervention, includes medication reconciliation at admission and discharge, medication review, increased communication with caregivers, providers, and retail pharmacies, and patient education and counseling during and after discharge. The intervention is being implemented in two large hospitals: Cedars-Sinai Medical Center and the Brigham and Women's Hospital. To evaluate the intervention, we are using a pragmatic, randomized clinical trial design with randomization at the patient level. The primary outcome is utilization within 30 days of hospital discharge, including unforeseen emergency department visits, observation stays, and readmissions. Randomizing 9776 patients will achieve 80% power to detect an absolute reduction of 2.5% from an estimated baseline rate of 27.5%. Qualitative analysis will use interviews with key stakeholders to study barriers to and facilitators of implementing PHARM-DC. A cost-effectiveness analysis using a time-and-motion study to estimate time spent on the intervention will highlight the potential cost savings per readmission. DISCUSSION: If this trial demonstrates a business case for the PHARM-DC intervention, with few barriers to implementation, hospitals may be much more likely to adopt pharmacist-led peri-discharge medication management programs. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04071951.