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Sponsored by: |
National Institute on Aging (NIA) |
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Information provided by: | National Institute on Aging (NIA) |
ClinicalTrials.gov Identifier: | NCT00182832 |
The purpose of this study is to evaluate the effectiveness of a cognitive screening program coupled with a computerized decision support system in improving the quality of care for hospitalized older adults with cognitive impairment.
Condition | Intervention |
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Cognitive Impairment Delirium |
Behavioral: e-CHAMP (Enhancing Care for Hospitalized Older Adults with Cognitive Impairment) Behavioral: Standard Care |
Study Type: | Interventional |
Study Design: | Prevention, Randomized, Double Blind (Subject, Caregiver, Investigator), Active Control, Parallel Assignment, Efficacy Study |
Official Title: | Enhancing Care for Hospitalized Older Adults With Cognitive Impairment |
Estimated Enrollment: | 400 |
Study Start Date: | June 2006 |
Estimated Study Completion Date: | December 2008 |
Estimated Primary Completion Date: | December 2008 (Final data collection date for primary outcome measure) |
Arms | Assigned Interventions |
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1: Experimental |
Behavioral: e-CHAMP (Enhancing Care for Hospitalized Older Adults with Cognitive Impairment)
Cognitive screening plus Computerized Decision Support System: proactive screening program for cognitive impairment combined with computerized review of the electronic medical record
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2: Active Comparator |
Behavioral: Standard Care
Standard care for hospitalized older patients with cognitive impairment
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A growing body of evidence demonstrates that older patients with cognitive impairment (CI) who are hospitalized for the management of their medical illnesses are especially vulnerable to hospital acquired complications such as falls, injuries, pressure ulcers, restraints, and delirium. These complications contribute to mortality, poorer functional status, limited rehabilitation, prolonged length of stay, increased institutionalization, and higher health care costs. Evidence suggests that interdisciplinary geriatric inpatient services improve care for hospitalized older adults without CI; however, their effectiveness among older adults with CI is less clear. One reason may be the ever-quickening pace of care in the hospital setting. Thus, matching geriatric evaluation and recommendations to the true pace of hospital care may be one mechanism to improve the care of older adults with CI.
A recent report from the Institute of Medicine suggested that integrating information technology (IT) into health care is the best route to improve the overall safety and quality of the health care system. The hypothesis of this study is that missed, delayed, post-hoc, and incomplete implementation of the geriatric service-based recommendations are significant factors explaining the poor outcomes among hospitalized older adults with cognitive impairment (CI). Wishard Memorial Hospital's physicians are already using a Computerized Decision Support System (CDSS), developed by the Regenstrief Institute, to guide their medical services. For this study, the content of this CDSS will be modified to the special needs of older adults with CI. A major advantage of such a system is reducing the time to implementation of geriatric recommendations with a specific focus on preventing the initiation of potentially harmful medications and procedures during the critical first 48 hours of hospitalization.
A total of 400 patients with cognitive impairment who have been hospitalized in a medical ward will be recruited for this study. Patients will be randomized to receive either standard care or the proactive screening program for CI combined with the modified CDSS. The electronic medical record for all patients will be reviewed for prescriptions for potentially inappropriate medications, urinary catheters, or physical restraints during the first 24 hours and the entire hospital stay. Medical records will be used to determine the total number of hospital acquired complications that may be related to CI; these include falls, injuries such as pulling out IV lines or urinary catheters, pressure ulcers, and new-onset delirium episodes that developed during hospitalization. Also, the time elapsed between screening for CI and the physician ordering a geriatric consultation will be calculated using the electronic medical record.
Ages Eligible for Study: | 65 Years and older |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Exclusion Criteria:
United States, Indiana | |
Wishard Memorial Hospital | |
Indianapolis, Indiana, United States, 46202 |
Principal Investigator: | Malaz Boustani, MD, MPH | Regenstrief Institute, IU Center for Aging Research |
Responsible Party: | Regenstrief Institute, IU Center for Aging Research ( Malaz Boustani, MD, MPH ) |
Study ID Numbers: | IA0077, K23AG026779-01 |
Study First Received: | September 9, 2005 |
Last Updated: | August 4, 2008 |
ClinicalTrials.gov Identifier: | NCT00182832 History of Changes |
Health Authority: | United States: Federal Government |
Physician Behavior Hospital Acquired Complications MCI Mild Cognitive Impairment |
Signs and Symptoms Delirium, Dementia, Amnestic, Cognitive Disorders Mental Disorders Neurologic Manifestations Confusion |
Dementia Neurobehavioral Manifestations Cognition Disorders Delirium |
Signs and Symptoms Delirium, Dementia, Amnestic, Cognitive Disorders Mental Disorders Nervous System Diseases Neurologic Manifestations |
Confusion Neurobehavioral Manifestations Cognition Disorders Delirium |