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
Cognitive Impairment Delirium	Behavior: Cognitive Screening plus Computerized Decision Support System

Further Study Details: 

Primary Outcomes: Use of potentially inappropriate medications, urinary catheter or physical restraints, and length of time in initiating a referral order, as recorded in the electronic medical record; Total number of hospital acquired complications recorded in the medical record that may be related to Cognitive Impairment (CI)
Secondary Outcomes: Length and cost of hospital stay from discharge records and billing system
Expected Total Enrollment:  400

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 above,  Genders Eligible for Study:  Both

Criteria

Inclusion Criteria:

• 65 years of age or older
• Hospitalized on a medical ward
• Able to speak English
• Cognitive impairment based on screening at time of hospital admission

Exclusion Criteria:

• Previously enrolled in the study during prior hospitalization (for multiple admissions, only data from the first admission will be used)
• Enrolled in another clinical trial
• Does not have cognitive impairment based on screening at time of hospital admission

Please refer to this study by ClinicalTrials.gov identifier  NCT00182832

Stephanie Munger, BS      317-630-7198    smunger@regenstrief.org

Indiana
      Wishard Memorial Hospital, Indianapolis,  Indiana,  46202,  United States

Study chairs or principal investigators

Malaz Boustani, MD, MPH,  Principal Investigator,  Regenstrief Institute, IU Center for Aging Research   

Study ID Numbers:  IA0077; K23AG026779-01
Last Updated:  September 15, 2005
Record first received:  September 9, 2005
ClinicalTrials.gov Identifier:  NCT00182832
Health Authority: United States: Federal Government
ClinicalTrials.gov processed this record on 2005-09-20