Development and Assessment of Diagnostic Accuracy of a Telemedicine-Based Delirium Assessment Tool (The Tele-CAM)

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PROJECT SUMMARY The overarching objective of this project is to develop and establish the diagnostic accuracy of a telemedicine- based delirium assessment tool, the TELE-CAM. Delirium, an acute change in cognition and attention is associated with a variety of undesirable outcomes including increased in-hospital mortality, long-term cognitive decline that mimics dementia, and increased risk for institutionalization. Delirium is prevalent in the post-operative population, and prevalence increases with age. Recent work performed by Dr. Austin and his research team demonstrated that many subjects were discharged home with active delirium. Patients discharged with active delirium to a nursing facility have worse outcomes than non-delirious patients. Despite the known negative effects of delirium in the post-acute care institution population, little is known about the impact of persistent delirium on functional recovery after discharge to the home setting. Current clinical diagnosis of delirium requires a face-to-face encounter, which limits the ability to feasibly perform frequent delirium assessments in the post-discharge setting. Over the past few years, devices that support videoconferencing, such as smart phones, have become commonplace. Concurrently, interest in telemedicine and remote diagnoses of cognitive disorders has grown. This interest has become even more acute due to the ongoing COVID-19 pandemic. We hypothesize that currently available videoconferencing capabilities can be easily and quickly utilized to perform reliable delirium assessments in older adults in the home setting. This project will refine and assess the diagnostic accuracy of a telemedicine-based delirium assessment tool based on the CAM (the TELE-CAM) that can be utilized in the home setting and assessed by remote researchers. We propose a prospective cohort study that will develop and refine this tool as well as demonstrate the feasibility of conducting in-home delirium assessments (Aim 1). We will also establish the diagnostic accuracy of our remote delirium assessment tool compared to a reference standard face-to-face assessment (Aim 2). We will enroll 400 older participants either hospitalized for an acute medical problem or major surgery for this project. The ability to perform in-home delirium assessments will prove invaluable to researchers investigating the appropriateness of discharging actively delirious patients’ home versus keeping them in the hospital until resolution of their delirium. Further, it will provide a method for clinicians to perform quick, remote delirium assessments of their patients.