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

一项随机对照试验，为从医院转移到熟练护理机构的接受多种药物治疗的老年患者开药

• 批准号: 9352922
• 负责人: SANDRA F SIMMONS
• 金额: $ 59.17万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9352922
• 关键词: Acute; Address; Adverse effects; Anti-Cholinergics; Area; Award; Caring; Clinical; Continuity of Patient Care; Coupled; Data; Delirium; Development; Dose; Elderly; Enrollment; Exposure to; Goals; Health; Health Status; Home environment; Hospitalization; Hospitals; Impaired cognition; Intervention; Life; Link; Literature; Low Prevalence; Medicare; Monitor; Organ; Outcome; Participant; Patient Discharge; Patient Preferences; Patients; Pharmaceutical Preparations; Pharmacists; Polypharmacy; Population; Preparation; Prevalence; Protocols documentation; Provider; Publishing; Randomized Controlled Trials; Reporting; Safety; Services; Severities; Skilled Nursing Facilities; Structure; Symptoms; Syndrome; Testing; United States Centers for Medicare and Medicaid Services; Universities; Urinary Incontinence; Weight; base; beneficiary; experience; falls; follow-up; frailty; high risk; improved outcome; indexing; innovation; intervention effect; medication compliance; meetings; novel; older patient; patient oriented; patient population; screening; sedative; systematic review

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.

项目总结