e-CHAMP: Enhancing Care for Hospitalized Older Adults With Memory Problems

Study Description

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Brief Summary:

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 or disease	Intervention/treatment	Phase
Cognitive Impairment; Delirium	Behavioral: e-CHAMP (Enhancing Care for Hospitalized Older Adults with Cognitive Impairment); Behavioral: Standard Care	Not Applicable

Detailed Description:

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.

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	424 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Masking:	Triple (Participant, Care Provider, Investigator)
Primary Purpose:	Prevention
Official Title:	Enhancing Care for Hospitalized Older Adults With Cognitive Impairment
Study Start Date :	June 2006
Actual Primary Completion Date :	December 2008
Actual Study Completion Date :	December 2008

Arms and Interventions

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Arm	Intervention/treatment
Experimental: 1	Behavioral: e-CHAMP (Enhancing Care for Hospitalized Older Adults with Cognitive Impairment); Cognitive screening plus Computerized Decision Support System: proactive screening program for cognitive impairment combined with computerized review of the electronic medical record; Other Name: CDSS
Active Comparator: 2	Behavioral: Standard Care; Standard care for hospitalized older patients with cognitive impairment

Outcome Measures

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Primary Outcome Measures :

1. 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 [ Time Frame: baseline and at discharge ]
2. Total number of hospital acquired complications recorded in the medical record that may be related to cognitive impairment (CI) [ Time Frame: baseline and at discharge ]

Secondary Outcome Measures :

1. Length and cost of hospital stay from discharge records and billing system [ Time Frame: baseline, at discharge, 6 months post-discharge ]

Eligibility Criteria

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Ages Eligible for Study:	65 Years and older (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

• 65 years of age or older
• Hospitalized in 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

Contacts and Locations

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Locations

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

Sponsors and Collaborators

Indiana University

National Institute on Aging (NIA)

Investigators

Principal Investigator:	Malaz Boustani, MD, MPH	Regenstrief Institute, Inc.

More Information

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Publications:

Saravay SM, Kaplowitz M, Kurek J, Zeman D, Pollack S, Novik S, Knowlton S, Brendel M, Hoffman L. How do delirium and dementia increase length of stay of elderly general medical inpatients? Psychosomatics. 2004 May-Jun;45(3):235-42.

Marcantonio ER, Goldman L, Mangione CM, Ludwig LE, Muraca B, Haslauer CM, Donaldson MC, Whittemore AD, Sugarbaker DJ, Poss R, et al. A clinical prediction rule for delirium after elective noncardiac surgery. JAMA. 1994 Jan 12;271(2):134-9.

Marcantonio ER, Juarez G, Goldman L, Mangione CM, Ludwig LE, Lind L, Katz N, Cook EF, Orav EJ, Lee TH. The relationship of postoperative delirium with psychoactive medications. JAMA. 1994 Nov 16;272(19):1518-22.

McCusker J, Cole MG, Dendukuri N, Belzile E. Does delirium increase hospital stay? J Am Geriatr Soc. 2003 Nov;51(11):1539-46.

Marcantonio ER, Flacker JM, Michaels M, Resnick NM. Delirium is independently associated with poor functional recovery after hip fracture. J Am Geriatr Soc. 2000 Jun;48(6):618-24.

Harwood DM, Hope T, Jacoby R. Cognitive impairment in medical inpatients. I: Screening for dementia--is history better than mental state? Age Ageing. 1997 Jan;26(1):31-5.

Responsible Party:	Malaz Boustani, MD, MPH, Principal Investigator, Regenstrief Institute, Inc.
ClinicalTrials.gov Identifier:	NCT00182832 History of Changes
Other Study ID Numbers:	IA0077; K23AG026770 ( U.S. NIH Grant/Contract ); K23AG026779-01
First Posted:	September 16, 2005
Last Update Posted:	April 13, 2016
Last Verified:	April 2016

Keywords provided by Malaz Boustani, MD, MPH, Regenstrief Institute, Inc.:

Physician Behavior; Hospital Acquired Complications; MCI; Mild Cognitive Impairment

Additional relevant MeSH terms:

Cognitive Dysfunction; Delirium; Cognition Disorders; Neurocognitive Disorders; Mental Disorders	Confusion; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms