Qualitative study develops ALICE framework for medication safety after discharge

Researchers interviewed 26 adults aged 60 or older who had been discharged from a hospital within the previous three months. Participants were recruited through two urban, safety-net primary care clinics in Western New York. The team used rapid qualitative analysis and cross-case comparison to examine patients’ experiences with medication safety during care transitions.

Six themes emerged: communication, discharge structure, patient involvement, social determinants of health, care coordination, and understanding treatment. Across these themes, participants described how patient engagement and perceived healthcare-system responsiveness could align or diverge. The researchers used these patterns to develop the Aligned Levels of Interaction for Collaborative Engagement (ALICE), a four-part typology: Collaborative Engagement, Patient-Driven Engagement, System-Driven Engagement, and Mutual Disengagement.

The framework offers a patient-centered way to describe engagement patterns that may help identify opportunities to improve medication safety during and after discharge. The study is qualitative and does not test whether applying ALICE reduces medication errors or readmissions. Its findings reflect interviews from a small, purposively sampled group at two clinics; medication changes and reconciliation processes could not be consistently verified through linked records.