Enhancing care for hospitalized older adults with cognitive impairment: A randomized controlled trial

Malaz Boustani, Noll L. Campbell, Babar Khan, Greg Abernathy, Mohammed Zawahiri, Tiffany Campbell, Jason Tricker, Siu Hui, John D. Buckley, Anthony J. Perkins, Mark O. Farber, Christopher Callahan

Research output: Contribution to journalArticle

29 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)561-567
Number of pages7
JournalJournal of General Internal Medicine
Volume27
Issue number5
DOIs
StatePublished - May 2012

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Randomized Controlled Trials
Clinical Decision Support Systems
Physical Restraint
Urinary Catheterization
Cholinergic Antagonists
Geriatrics
Quality of Health Care
Pharmaceutical Preparations
Physicians
Medical Informatics
National Academies of Science, Engineering, and Medicine (U.S.) Health and Medicine Division
Public Hospitals
Cognitive Dysfunction
African Americans
Referral and Consultation
Delivery of Health Care
Safety
Control Groups

Keywords

  • Clinical trial
  • Cognitive impairment
  • Decision support
  • Hospitalized elders

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Enhancing care for hospitalized older adults with cognitive impairment : A randomized controlled trial. / Boustani, Malaz; Campbell, Noll L.; Khan, Babar; Abernathy, Greg; Zawahiri, Mohammed; Campbell, Tiffany; Tricker, Jason; Hui, Siu; Buckley, John D.; Perkins, Anthony J.; Farber, Mark O.; Callahan, Christopher.

In: Journal of General Internal Medicine, Vol. 27, No. 5, 05.2012, p. 561-567.

Research output: Contribution to journalArticle

Boustani, Malaz ; Campbell, Noll L. ; Khan, Babar ; Abernathy, Greg ; Zawahiri, Mohammed ; Campbell, Tiffany ; Tricker, Jason ; Hui, Siu ; Buckley, John D. ; Perkins, Anthony J. ; Farber, Mark O. ; Callahan, Christopher. / Enhancing care for hospitalized older adults with cognitive impairment : A randomized controlled trial. In: Journal of General Internal Medicine. 2012 ; Vol. 27, No. 5. pp. 561-567.
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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.",
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AU - Boustani, Malaz

AU - Campbell, Noll L.

AU - Khan, Babar

AU - Abernathy, Greg

AU - Zawahiri, Mohammed

AU - Campbell, Tiffany

AU - Tricker, Jason

AU - Hui, Siu

AU - Buckley, John D.

AU - Perkins, Anthony J.

AU - Farber, Mark O.

AU - Callahan, Christopher

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N2 - 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.

AB - 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.

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KW - Decision support

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