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 出院到熟练护理设施(SNF)的住院老年人的药物暴露情况。这 研究将在一所大学附属医院和14个地区的SNF进行，以招收约1300人 五个项目年的参与者总数。出院到SNF的患者是最大的一部分 医疗保险受益人出院后接受急性护理服务，是失去 独立性和其他不良的临床结果。这个调查小组最近完成了一个中心的 Medicare和Medicaid Services(CMS)创新奖，该奖项提供了与以下方面相关的强大初步数据 多药房的流行以及多药房和老年综合征之间的关系(例如， 与跌倒相关的药物)。基于这些数据，我们开发了一个结构化的 非处方干预方案(“SHOAD-MEDS”)与标准化的筛查评估相结合，共8项 老年综合征将在医院实施，并在三军部队逗留期间继续。的目标是 干预措施是安全地停药，根据剂量减少和停药的定义， 基于临床标准和患者喜好的组合。我们已经对我们以患者为中心的 为准备这项提案而进行的干预工作取得了可喜的成果。拟议中的试验将评估效果 关于用药暴露、用药依从性、老年综合征和健康状况的干预 在从医院到SNF再到家庭的整个护理过渡中，包括SNF后90天的随访期 出院。我们最重要的假设是，减少老年患者的药物治疗 护理将有利地影响老年综合症。

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.