Enhancing Care for Hospitalized Older Adults with Cognitive Impairment: A Randomized Controlled Trial
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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.
Evaluate the efficacy of a clinical decision support system (CDSS) to improve the quality of care for hospitalized older adults with CI.
A randomized controlled clinical trial.
A public hospital in Indianapolis.
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.
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.
Orders of a geriatric consult and discontinuation orders of Foley catheterization, physical restraints, or anticholinergic drugs.
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).
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.
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- Enhancing Care for Hospitalized Older Adults with Cognitive Impairment: A Randomized Controlled Trial
Journal of General Internal Medicine
Volume 27, Issue 5 , pp 561-567
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- cognitive impairment
- clinical trial
- decision support
- hospitalized elders
- Industry Sectors
- 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)
- Author Affiliations
- 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