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- Title
Enhancing Care for Hospitalized Older Adults with Cognitive Impairment: A Randomized Controlled Trial.
- Authors
Boustani, Malaz; Campbell, Noll; Khan, Babar; Abernathy, Greg; Zawahiri, Mohammed; Campbell, Tiffany; Tricker, Jason; Hui, Siu; Buckley, John; Perkins, Anthony; Farber, Mark; Callahan, Christopher
- Abstract
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 = 0.86); physical restraints (4.8% vs 0%, P = 0.86), or anticholinergic drugs (48.9% vs 31.2%, P = 0.11). 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.
- Subjects
HOSPITAL care of older people; HOSPITAL patients; NOSOCOMIAL infections; RANDOMIZED controlled trials; COGNITION disorders in old age
- Publication
JGIM: Journal of General Internal Medicine, 2012, Vol 27, Issue 5, p561
- ISSN
0884-8734
- Publication type
Article
- DOI
10.1007/s11606-012-1994-8