Improving Use of Sedating Medications in Hospitalized Older Adults

改善住院老年人镇静药物的使用

• 批准号: 8867975
• 负责人: Shoshana J Herzig
• 金额: $ 15.66万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8867975
• 关键词: Address; Admission activity; Adverse drug event; Adverse event; Age; Aging; Antipsychotic Agents; Area; Benefits and Risks; Caring; Comorbidity; Cross-Sectional Studies; Data Set; Databases; Development; Dose; Drug Kinetics; Elderly; Epidemiologic Methods; Future; Goals; Health; Hospitals; Inpatients; Intervention; Israel; Knowledge; Lead; Learning; Measures; Medical center; Mental Depression; Mentorship; Methods; Nature; Neuraxis; Nosocomial pneumonia; Opiates; Outcome; Patients; Pattern; Pharmaceutical Preparations; Pharmacodynamics; Pharmacoepidemiology; Phase; Pilot Projects; Polypharmacy; Predisposition; Preventive Intervention; Randomized Controlled Trials; Reporting; Research; Research Personnel; Risk; Risk Factors; Series; Site; Suggestion; Testing; Time; Training; Translating; Work; aged; base; clinical care; cohort; computerized; falls; high risk; hypnotic; improved; modifiable risk; older patient; patient oriented; patient population; patient safety; repository; sedative; skills; statistics; therapy development; tool

DESCRIPTION (provided by applicant): The broad goal of the work in this application is to improve the care of hospitalized older adults through safer medication prescribing practices. More specifically, the objectives of this proposal are to define current usage patterns and risks of sedating medications in hospitalized patients, and use this knowledge to develop an intervention to promote safer prescribing. This work will be carried out in two phases. First, two large existing hospital data repositories will be used in a parallel and complementary fashion to investigate current usage patterns of sedating medications and their association with specific hypothesized risks - hospital-acquired pneumonia and in-hospital falls - in two large cohorts of hospitalized patients. These analyses will employ advanced epidemiologic methods for confounder control, including propensity score and instrumental variable approaches. In the second phase of this work, the information gained from the first phase will be combined with existing knowledge related to safe prescribing practices to develop and conduct a pilot study of a computerized decision support (CDS) tool that bundles prescribing suggestions with specific preventive interventions for those at highest risk. The impact of this CDS tool on safe prescribing practices will be investigated, and this information will be used to inform development of a multi-site, cluster randomized controlled trial as part of a future R01 submission. Through these analyses, her planned coursework, and strong mentorship, the candidate, Dr. Shoshana Herzig, will advance her methodological skills in pharmacoepidemiologic analysis and aging research. She will also further develop her ability to translate research findings into interventions that will successfully impact the clinical care of older hospitalized patients, and learn the methods necessary to rigorously measure that impact. Taken together, this multi-faceted proposal will facilitate Dr. Herzig's development into an independent patient-oriented investigator in geriatric pharmacoepidemiology.

描述（由申请人提供）：本申请工作的总体目标是通过更安全的药物处方实践来改善住院老年人的护理。更具体地说，该提案的目标是确定住院患者目前镇静药物的使用模式和风险，并利用这些知识制定干预措施，以促进更安全的处方。这项工作将分两个阶段进行。首先，将以并行和互补的方式使用两个大型现有医院数据存储库，以调查目前镇静药物的使用模式及其与两大住院患者的特定假设风险（医院获得性肺炎和院内跌倒）的关联。这些分析将采用先进的流行病学方法来控制混杂因素，包括倾向评分和工具变量方法。在这项工作的第二阶段，从第一阶段获得的信息将与安全处方实践相关的现有知识相结合，开发和开展计算机化决策支持（CDS）工具的试点研究，该工具将处方建议与针对高风险人群的具体预防干预措施捆绑在一起。我们将调查该 CDS 工具对安全处方实践的影响，并且该信息将用于为多中心、集群随机对照试验的开发提供信息，作为未来 R01 提交的一部分。通过这些分析、她计划的课程作业和强有力的指导，候选人 Shoshana Herzig 博士将提高她在药物流行病学分析和衰老研究方面的方法学技能。她还将进一步发展将研究成果转化为干预措施的能力，从而成功影响老年住院患者的临床护理，并学习严格衡量这种影响所需的方法。总而言之，这一多方面的建议将有助于 Herzig 博士发展成为老年药物流行病学领域以患者为中心的独立研究者。