Enhancing Care for Hospitalized Older Adults with Cognitive Impairment: A Randomized Controlled Trial

BackgroundApproximately 40% of hospitalized older adults have cognitive impairment (CI) and are more prone to hospital-acquired complications. The Institute of Medicine suggests using health information technology to improve the overall safety and quality of the health care system.ObjectiveEvaluate the efficacy of a clinical decision support system (CDSS) to improve the quality of care for hospitalized older adults with CI.DesignA randomized controlled clinical trial.SettingA public hospital in Indianapolis.PopulationA total of 998 hospitalized older adults were screened for CI, and 424 patients (225 intervention, 199 control) with CI were enrolled in the trial with a mean age of 74.8, 59% African Americans, and 68% female.InterventionA CDSS alerts the physicians of the presence of CI, recommends early referral into a geriatric consult, and suggests discontinuation of the use of Foley catheterization, physical restraints, and anticholinergic drugs.MeasurementsOrders of a geriatric consult and discontinuation orders of Foley catheterization, physical restraints, or anticholinergic drugs.ResultsUsing intent-to-treat analyses, there were no differences between the intervention and the control groups in geriatric consult orders (56% vs 49%, P = 0.21); discontinuation orders for Foley catheterization (61.7% vs 64.6%, P = 0.86); physical restraints (4.8% vs 0%, P = 0.86), or anticholinergic drugs (48.9% vs 31.2%, P = 0.11).ConclusionA simple screening program for CI followed by a CDSS did not change physician prescribing behaviors or improve the process of care for hospitalized older adults with CI.