Trial record 1 of 1 for:    NCT00182832
Previous Study | Return to List | Next Study

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

This study has been completed.
Sponsor:
Collaborator:
Information provided by (Responsible Party):
Malaz Boustani, Regenstrief Institute, IU Center for Aging Research
ClinicalTrials.gov Identifier:
NCT00182832
First received: September 9, 2005
Last updated: September 20, 2012
Last verified: September 2012
  Purpose

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
Behavioral: e-CHAMP (Enhancing Care for Hospitalized Older Adults with Cognitive Impairment)
Behavioral: Standard Care

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator)
Primary Purpose: Prevention
Official Title: Enhancing Care for Hospitalized Older Adults With Cognitive Impairment

Resource links provided by NLM:


Further study details as provided by Regenstrief Institute, IU Center for Aging Research:

Primary Outcome Measures:
  • 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 ] [ Designated as safety issue: No ]
  • 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 ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Length and cost of hospital stay from discharge records and billing system [ Time Frame: baseline, at discharge, 6 months post-discharge ] [ Designated as safety issue: No ]

Enrollment: 424
Study Start Date: June 2006
Study Completion Date: December 2008
Primary Completion Date: December 2008 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
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

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.

  Eligibility

Ages Eligible for Study:   65 Years and older
Genders Eligible for Study:   Both
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
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: NCT00182832

Locations
United States, Indiana
Wishard Memorial Hospital
Indianapolis, Indiana, United States, 46202
Sponsors and Collaborators
Regenstrief Institute, IU Center for Aging Research
Investigators
Principal Investigator: Malaz Boustani, MD, MPH Regenstrief Institute, IU Center for Aging Research
  More Information

Publications:
Responsible Party: Malaz Boustani, Principal Investigator, Regenstrief Institute, IU Center for Aging Research
ClinicalTrials.gov Identifier: NCT00182832     History of Changes
Other Study ID Numbers: IA0077, K23AG026770, K23AG026779-01
Study First Received: September 9, 2005
Last Updated: September 20, 2012
Health Authority: United States: Federal Government

Keywords provided by Regenstrief Institute, IU Center for Aging Research:
Physician Behavior
Hospital Acquired Complications
MCI
Mild Cognitive Impairment

Additional relevant MeSH terms:
Cognition Disorders
Delirium, Dementia, Amnestic, Cognitive Disorders
Mental Disorders

ClinicalTrials.gov processed this record on October 19, 2014