A Randomized Controlled Trial to Deprescribe for Older Patients with Polypharmacy Transferred from the Hospital to Skilled Nursing Facilities

项目摘要 拟议的随机对照试验将评估干预措施的效果，以减少 出院到专业护理机构（SNF）的住院老年人的药物暴露。这 研究将在一所大学附属医院和14个地区SNF进行，招募约1300人 五个项目年度的参与者总数。出院至SNF的患者代表了 医疗保险受益人出院后的急性护理服务，是一个特别高风险的群体损失 独立性和其他不良临床结果。这个调查小组最近完成了一个中心， 医疗保险和医疗补助服务（CMS）创新奖，该奖项提供了与以下方面相关的强大初步数据： 多种药物的流行以及多种药物与老年综合征之间的关系（例如， 与福尔斯相关的药物）。基于这些数据，我们开发了一个结构化的 取消处方干预方案（"Shed-Meds"），加上标准化的筛选评估， 老年综合征将在医院实施，并在SNF住院期间继续。的目标 干预是安全地取消药物处方，如剂量减少和停止药物治疗所定义的， 基于临床标准和患者偏好的组合。我们已经对以病人为中心的 为准备这一提案进行了干预，取得了可喜的成果。拟议中的试验将评估 这种干预对药物暴露、药物依从性、老年综合征和健康状况的影响 从医院到SNF再到家庭的护理过渡期间，包括SNF后90天的随访期 放电我们的总体假设是，减少老年患者的药物治疗， 护理将有利地影响老年综合征。

Project Summary The proposed randomized, controlled trial will evaluate the effects of an intervention to reduce exposure to medications among hospitalized older adults discharged to skilled nursing facilities (SNFs). This study will be conducted in one university-affiliated hospital and 14 area SNFs to enroll approximately 1,300 total participants across five project years. Patients discharged to SNF represent the largest segment of Medicare beneficiaries discharged to post-acute care services and are a particularly high risk group for loss of independence and other poor clinical outcomes. This investigative team recently completed a Centers for Medicare and Medicaid Services (CMS) Innovation Award, which provides strong preliminary data related to the prevalence of polypharmacy and the relationship between polypharmacy and geriatric syndromes (e.g., medications associated with falls) in this patient population. Based on these data, we developed a structured deprescribing intervention protocol (“Shed-Meds”) coupled with standardized screening assessments for eight geriatric syndromes to be implemented in the hospital and continued during the SNF stay. The goal of the intervention is to safely deprescribe medications, as defined by dose reductions and stopped medications, based on a combination of clinical criteria and patient preferences. We have pilot-tested our patient-centered intervention in preparation for this proposal with promising results. The proposed trial will evaluate the effects of this intervention on medication exposure, medication adherence, geriatric syndromes, and health status across the care transitions from hospital to SNF to home to include a 90-day follow-up period after SNF discharge. Our overarching hypothesis is that reducing medications for older patients across the continuum of care will favorably impact geriatric syndromes.