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

September 9, 2005
September 20, 2012
June 2006
December 2008   (final data collection date for primary outcome measure)
  • 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 ]
  • 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)
Complete list of historical versions of study NCT00182832 on ClinicalTrials.gov Archive Site
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 ]
Length and cost of hospital stay from discharge records and billing system
Not Provided
Not Provided
 
e-CHAMP: Enhancing Care for Hospitalized Older Adults With Memory Problems
Enhancing Care for Hospitalized Older Adults With Cognitive Impairment

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.

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.

Interventional
Not Provided
Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator)
Primary Purpose: Prevention
  • Cognitive Impairment
  • Delirium
  • 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
  • Behavioral: Standard Care
    Standard care for hospitalized older patients with cognitive impairment
  • Experimental: 1
    Intervention: Behavioral: e-CHAMP (Enhancing Care for Hospitalized Older Adults with Cognitive Impairment)
  • Active Comparator: 2
    Intervention: Behavioral: Standard Care

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
424
December 2008
December 2008   (final data collection date for primary outcome measure)

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
Both
65 Years and older
No
Contact information is only displayed when the study is recruiting subjects
United States
 
NCT00182832
IA0077, K23AG026770, K23AG026779-01
No
Malaz Boustani, Regenstrief Institute, IU Center for Aging Research
Regenstrief Institute, IU Center for Aging Research
National Institute on Aging (NIA)
Principal Investigator: Malaz Boustani, MD, MPH Regenstrief Institute, IU Center for Aging Research
Regenstrief Institute, IU Center for Aging Research
September 2012

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP