Enhancing care for hospitalized older adults with cognitive impairment: a randomized controlled trial.
BACKGROUND
Approximately 40% of hospitalized older adults have cognitive impairment (CI) and are more prone to hospital-acquired complications. The Institute of Medicine suggests using health information technology to improve the overall safety and quality of the health care system.


OBJECTIVE
Evaluate the efficacy of a clinical decision support system (CDSS) to improve the quality of care for hospitalized older adults with CI.


METHODS
A randomized controlled clinical trial.


METHODS
A public hospital in Indianapolis.


METHODS
A total of 998 hospitalized older adults were screened for CI, and 424 patients (225 intervention, 199 control) with CI were enrolled in the trial with a mean age of 74.8, 59% African Americans, and 68% female.


METHODS
A CDSS alerts the physicians of the presence of CI, recommends early referral into a geriatric consult, and suggests discontinuation of the use of Foley catheterization, physical restraints, and anticholinergic drugs.


METHODS
Orders of a geriatric consult and discontinuation orders of Foley catheterization, physical restraints, or anticholinergic drugs.


RESULTS
Using intent-to-treat analyses, there were no differences between the intervention and the control groups in geriatric consult orders (56% vs 49%, P = 0.21); discontinuation orders for Foley catheterization (61.7% vs 64.6%, P = 0.86); physical restraints (4.8% vs 0%, P = 0.86), or anticholinergic drugs (48.9% vs 31.2%, P = 0.11).


CONCLUSIONS
A simple screening program for CI followed by a CDSS did not change physician prescribing behaviors or improve the process of care for hospitalized older adults with CI.
Indiana University Center for Aging Research, Indianapolis, IN, USA. mboustan@iupui.edu
Malaz A
MA
Boustani
Noll L
NL
Campbell
Babar A
BA
Khan
Greg
G
Abernathy
Mohammed
M
Zawahiri
Tiffany
T
Campbell
Jason
J
Tricker
Siu L
SL
Hui
John D
JD
Buckley
Anthony J
AJ
Perkins
Mark O
MO
Farber
Christopher M
CM
Callahan
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000628:therapy*; D020000:Decision Support Systems, Clinical; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D011787:Quality of Health Care; D011795:Surveys and Questionnaires