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

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

Research output: Contribution to journalArticle

30 Scopus citations

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 (US)
Pages (from-to)561-567
Number of pages7
JournalJournal of general internal medicine
Volume27
Issue number5
DOIs
StatePublished - May 1 2012

Keywords

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

ASJC Scopus subject areas

  • Internal Medicine

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