Enhancing Care for Hospitalized Older Adults with Cognitive Impairment: A Randomized Controlled Trial
Enhancing Care for Hospitalized Older Adults with Cognitive Impairment: A Randomized Controlled Trial
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DOI：
10.1007/s11606-012-1994-8
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发表时间：
2012-05-01
影响因子：
5.7
通讯作者：
Callahan, Christopher M.
中科院分区：
文献类型：
--
作者：
Boustani, Malaz A.;Campbell, Noll L.;Callahan, Christopher M.
大约 40% 的住院老年人患有认知障碍 (CI)，并且更容易出现医院获得性并发症。医学研究所建议利用健康信息技术来提高医疗保健系统的整体安全性和质量。评估临床决策支持系统（CDSS）的有效性，以提高住院老年 CI 的护理质量。一项随机对照临床试验。印第安纳波利斯市的一家公立医院。共对 998 名住院老年人进行了 CI 筛查，424 名 CI 患者（225 名干预，199 名对照）入组，平均年龄为74.8，59% 非裔美国人，68% 女性。CDSS 提醒医生 CI 的存在，建议及早转诊至老年科会诊，并建议停止使用 Foley 导管插入术、身体约束和抗胆碱能药物。老年科会诊的命令和停止使用 Foley 导管插入术、身体约束或抗胆碱能药物的命令。使用意向性治疗分析，有干预组和对照组在老年科会诊方面没有差异（56% vs 49%，P = 0.21）；终止 Foley 导尿术的命令（61.7% vs 64.6%，P = 0.86）；身体束缚（4.8% vs 0%，P = 0.86），或抗胆碱能药物（48.9% vs 31.2%，P = 0.11）。简单的 CI 筛查计划和 CDSS 并没有改变医生的处方行为或改善住院老年 CI 患者的护理过程。
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.Evaluate the efficacy of a clinical decision support system (CDSS) to improve the quality of care for hospitalized older adults with CI.A randomized controlled clinical trial.A public hospital in Indianapolis.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.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.Orders of a geriatric consult and discontinuation orders of Foley catheterization, physical restraints, or anticholinergic drugs.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).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.