Enhancing Care for Hospitalized Older Adults with Cognitive Impairment: A Randomized Controlled Trial

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• 作者：Malaz A. Boustani MD ; MPH (1) (2) (3)
  Noll L. Campbell PharmD (1) (2) (4) (5)
  Babar A. Khan MD (3)
  Greg Abernathy MD (2)
  Mohammed Zawahiri MD (1) (2)
  Tiffany Campbell BS (1) (2)
  Jason Tricker NP (3)
  Siu L. Hui PhD (1) (2) (3)
  John D. Buckley MD (1) (2) (3)
  Anthony J. Perkins MS (2)
  Mark O. Farber MD (3)
  Christopher M. Callahan MD (1) (2) (3)
  
• 关键词：cognitive impairment ; clinical trial ; decision support ; hospitalized elders
• 刊名：Journal of General Internal Medicine
• 出版年：2012
• 出版时间：May 2012
• 年：2012
• 卷：27
• 期：5
• 页码：561-567
• 全文大小：386KB
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• 作者单位：Malaz A. Boustani MD, MPH (1) (2) (3)
  Noll L. Campbell PharmD (1) (2) (4) (5)
  Babar A. Khan MD (3)
  Greg Abernathy MD (2)
  Mohammed Zawahiri MD (1) (2)
  Tiffany Campbell BS (1) (2)
  Jason Tricker NP (3)
  Siu L. Hui PhD (1) (2) (3)
  John D. Buckley MD (1) (2) (3)
  Anthony J. Perkins MS (2)
  Mark O. Farber MD (3)
  Christopher M. Callahan MD (1) (2) (3)
  
  1. Indiana University Center for Aging Research, Indianapolis, IN, USA
  2. Regenstrief Institute, Inc, 410 West 10th Street, Suite 2000, Indianapolis, IN, 46202, USA
  3. Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
  4. Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
  5. Department of Pharmacy, Wishard Health Services, Indianapolis, IN, USA
  

文摘

Background Approximately 40% of hospitalized older adults have cognitive impairment (CI) and are more prone to hospital-acquired complications. The Institute of Medicine suggests using health information technology to improve the overall safety and quality of the health care system. Objective Evaluate the efficacy of a clinical decision support system (CDSS) to improve the quality of care for hospitalized older adults with CI. Design A randomized controlled clinical trial. Setting A public hospital in Indianapolis. Population A total of 998 hospitalized older adults were screened for CI, and 424 patients (225 intervention, 199 control) with CI were enrolled in the trial with a mean age of 74.8, 59% African Americans, and 68% female. Intervention A CDSS alerts the physicians of the presence of CI, recommends early referral into a geriatric consult, and suggests discontinuation of the use of Foley catheterization, physical restraints, and anticholinergic drugs. Measurements Orders of a geriatric consult and discontinuation orders of Foley catheterization, physical restraints, or anticholinergic drugs. Results Using intent-to-treat analyses, there were no differences between the intervention and the control groups in geriatric consult orders (56% vs 49%, P = 0.21); discontinuation orders for Foley catheterization (61.7% vs 64.6%, P--.86); physical restraints (4.8% vs 0%, P--.86), or anticholinergic drugs (48.9% vs 31.2%, P--.11). Conclusion A simple screening program for CI followed by a CDSS did not change physician prescribing behaviors or improve the process of care for hospitalized older adults with CI.