Acute Care for Elders (ACE) Program at OHSU Hospital

This study is currently recruiting participants. (see Contacts and Locations)
Verified April 2014 by Oregon Health and Science University
Sponsor:
Information provided by (Responsible Party):
Juliana Bernstein, Oregon Health and Science University
ClinicalTrials.gov Identifier:
NCT02119078
First received: April 8, 2014
Last updated: April 17, 2014
Last verified: April 2014
  Purpose

The purpose of this investigation is to assess the effectiveness of a multi-disciplinary Acute Care for Elders (ACE) program dedicated to the care of patients age 70 and older admitted to Oregon Health & Science University's hospital medicine service. The ACE program will aim to improve the quality of care of older patients in the investigators hospital by implementing focused interventions and recommendations specific to geriatric needs and syndromes, including: reduced fall rate, decreased incidence and duration of delirium, early recognition and treatment of impaired mobility and function, careful minimization of medication use, prevention of unnecessary catheter and restraint use, decreased hospital readmission rates, improved transitional care following hospital discharge, and high levels of patient and referring physician satisfaction. Additionally, the ACE program aims to improve resident and student competence in treating geriatric syndromes, and to improve staff and learner satisfaction with caring for older adults. ACE programs have been well studied at other institutions, so the investigators will be implementing a program that is already standard of care, and studying the elements that are unique to OHSU.

This will be a quality improvement project. Study participants will be a convenience sample of OHSU faculty, staff, residents and students who are employed by or on rotation with General Medicine Team 1 of the Medicine Teaching Service. Faculty, staff, and learners (ACE team members) will receive the ACE training. Study personnel will conduct prospective and retrospective chart review of patients admitted to the ACE service to determine outcomes as noted above.


Condition Intervention
Delirium
Age-Related Cognitive Decline
Frail Elderly
Hospital Acquired Pressure Ulcer
Drug-Related Side Effects and Adverse Reactions
Other: Acute Care of Elders focused geriatric care

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Health Services Research
Official Title: Acute Care for Elders (ACE) Program at OHSU Hospital

Resource links provided by NLM:


Further study details as provided by Oregon Health and Science University:

Primary Outcome Measures:
  • Number of geriatric patients with adverse events [ Time Frame: During hospitalization, an expected average of 6 days ] [ Designated as safety issue: Yes ]
    Incidence and duration of delirium (source: hospital problem list); incidence of hospital-acquired pressure ulcers (source: nursing documentation, problem list); number of prescriptions for Beers List medications during hospitalization and upon discharge (source: MAR)


Secondary Outcome Measures:
  • Resident confidence in treating geriatric syndromes [ Time Frame: After 3 week rotation on the Acute Care for Elders service ] [ Designated as safety issue: No ]
    As measured by the Post-ACE Survey resident questionnaire, which includes 17 metrics of confidence (e.g. management of pain, identification of fall risk factors, delivering bad news, discussion of hospice care, performing a complete skin exam, documenting advanced directives, managing insomnia, performing bedside cognitive assessments.)


Estimated Enrollment: 300
Study Start Date: January 2014
Estimated Primary Completion Date: January 2017 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: ACE Service
Admission to the Acute Care for Elders (General Medicine Team 1) service. (See Intervention, below)
Other: Acute Care of Elders focused geriatric care
Patients admitted to the ACE Service will receive standard care as well as additional use of geriatric-specific order sets and protocols and oversight of care by a geriatric-trained Advanced Practice Provider (APP).
No Intervention: Standard care (other General Medicine teams)
Admission to one of the 4 non-ACE general medicine teaching teams at OHSU.

  Eligibility

Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria (ACE faculty, health care providers and students):

  • employed by OHSU or enrolled in one of OHSU's schools (medicine, nursing, pharmacy)
  • share in the care of older adults on the General Medicine Team 1 service.

Inclusion Criteria (patients):

  • admitted to the internal medicine service during the time frame of the study
  • age 70 or older at time of hospital admission

Exclusion Criteria (ACE faculty, health care providers and students):

  • non-English-speaking

Exclusion Criteria (patients):

  • none
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT02119078

Contacts
Contact: Juliana M Bernstein, MPAS, PA-C 503-494-1088 bernstej@ohsu.edu

Locations
United States, Oregon
Oregon Health & Science University Hospital Recruiting
Portland, Oregon, United States, 97239
Contact: Juliana M Bernstein, MPAS, PA-C    503-494-1088    bernstej@ohsu.edu   
Principal Investigator: Juliana M Bernstein, MPAS, PA-C         
Sponsors and Collaborators
Oregon Health and Science University
Investigators
Principal Investigator: Juliana M Bernstein, MPAS, PA-C Oregon Health and Science University
  More Information

No publications provided

Responsible Party: Juliana Bernstein, Assistant Professor, Physician Assistant, Oregon Health and Science University
ClinicalTrials.gov Identifier: NCT02119078     History of Changes
Other Study ID Numbers: RB00010420
Study First Received: April 8, 2014
Last Updated: April 17, 2014
Health Authority: United States: Institutional Review Board

Keywords provided by Oregon Health and Science University:
Geriatrics
Acute Care for Elders
Geriatric syndromes
Delirium
Falls
Polypharmacy

Additional relevant MeSH terms:
Pressure Ulcer
Delirium
Cognition Disorders
Skin Ulcer
Skin Diseases
Confusion
Neurobehavioral Manifestations
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms
Delirium, Dementia, Amnestic, Cognitive Disorders
Mental Disorders

ClinicalTrials.gov processed this record on July 28, 2014