Reducing cognitive decline in patients with mild cognitive impairment and Alzheimer's Disease and related dementias by developing and testing clinician and caregiver deprescribing tools
通过开发和测试临床医生和护理人员处方工具,减少轻度认知障碍、阿尔茨海默氏病和相关痴呆症患者的认知能力下降
基本信息
- 批准号:10370471
- 负责人:
- 金额:$ 51.1万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2022
- 资助国家:美国
- 起止时间:2022-02-01 至 2024-07-31
- 项目状态:已结题
- 来源:
- 关键词:AddressAdoptionAlzheimer&aposs disease related dementiaAnti-CholinergicsBehavioralBehavioral SciencesBenzodiazepinesCaregiversClinicalCognitionCommunicationDataDoseElderlyElectronic Health RecordEnsureEvaluationFundingImpaired cognitionInterventionInterviewLearningLiteratureMedication ManagementMonitorPatientsPharmaceutical PreparationsPopulationProcessResearch PersonnelResourcesSurveysSystemTelephoneTestingVisitWorkbasebehavior changecare providerscaregivingclinical practicecognitive loaddashboarddesignhigh riskhypnoticimplementation evaluationimplementation outcomesimprovedimproved outcomeinnovationinsightmild cognitive impairmentmultidisciplinarypatient health informationpatient portalpilot testpoint of carepragmatic trialprovider behaviorresearch studysedativeside effectsuccesssupport toolstoolusability
项目摘要
Worsening cognitive decline is a hallmark problem in patients with mild cognitive impairment (MCI) and
Alzheimer’s Disease and related dementias (ADRD). Despite the well-recognized worsening of cognitive
burden by high-risk medications like benzodiazepines, medications with strong anticholinergic side effects, and
sedative hypnotics, they continue to be overprescribed in this population. Many factors contribute to their
overuse including clinical inertia and the need to involve caregivers. Fortunately, deprescribing has been
shown to improve outcomes in patients with MCI/ADRD. However, deprescribing efforts have often had
modest success due to lack of primary care provider (PCP) involvement and giving insufficient support at the
point of care. Interventions that have been successful have been resource intensive and thus difficult to scale.
In contrast, electronic health record (EHR) systems offer a scalable strategy for changing provider
behavior that could be useful for deprescribing medications that worsen cognitive burden. Existing literature
demonstrates the potential for EHR-based tools to improve deprescribing, especially when augmented with
insights from behavioral science. EHR systems could also be leveraged to engage caregivers in the
deprescribing process but has not been done before. Despite the high potential for scalability, application of
specific deprescribing tools in EHRs for PCPs has been limited, especially for MCI/ADRD populations.
To overcome this gap, we propose this R21 to develop and pilot test new EHR deprescribing tools for
PCPs of patients with MCI/ADRD that also involve caregivers. We will leverage learnings from our NUDGE-
EHR trial, an NIA-funded pragmatic trial evaluating whether EHR tools designed using behavioral science
improves deprescribing in general older adults and adapt them for the MCI/ADRD population to provide pilot
data for a subsequent large pragmatic trial and generalizable evidence about caregiver engagement strategies.
The specific aims are: (1) to design and pilot test EHR tools using behavioral science for deprescribing in
patients with MCI/ADRD and (2) to identify strategies for engaging caregivers in EHR tools. The new tools will
include a PCP-facing EHR dashboard that identifies patients in need of deprescribing and facilitates
communication with caregivers, alerts enhanced with behavioral principles to encourage deprescribing, order
sets that provide easier ordering of dose-tapers and alternative medications, and post-visit monitoring tools.
We will conduct qualitative interviews and pilot testing within the EHR system with PCPs and caregivers to
demonstrate feasibility and usability of the EHR tools, also assessing implementation outcomes to identify
barriers to intervention scalability. In addition, we will evaluate the ability to engage caregivers using caregiver-
facing surveys delivered through EHR patient portal, emailed, phone, and mailed communications. The
expected overall impact of this innovative proposal is that it will advance how EHRs can be optimized to
improve prescribing for patients with MCI/ADRD to improve cognitive burden in ways that are highly scalable.
认知能力下降恶化是轻度认知障碍(MCI)患者的一个标志性问题
项目成果
期刊论文数量(0)
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Julie Christine Lauffenburger其他文献
Julie Christine Lauffenburger的其他文献
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{{ truncateString('Julie Christine Lauffenburger', 18)}}的其他基金
Development of a novel medication adherability tool to improve cardiovascular disease management
开发新型药物依从性工具以改善心血管疾病管理
- 批准号:
10132378 - 财政年份:2018
- 资助金额:
$ 51.1万 - 项目类别:
Development of a novel medication adherability tool to improve cardiovascular disease management
开发新型药物依从性工具以改善心血管疾病管理
- 批准号:
9886260 - 财政年份:2018
- 资助金额:
$ 51.1万 - 项目类别:
Development of a novel medication adherability tool to improve cardiovascular disease management
开发新型药物依从性工具以改善心血管疾病管理
- 批准号:
10375402 - 财政年份:2018
- 资助金额:
$ 51.1万 - 项目类别:
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