Enhancing Care Coordination: Hospital to Home for Cognitively Impaired Older Adults and Their Caregivers
| Status: | Completed |
|---|---|
| Conditions: | Alzheimer Disease, Cognitive Studies, Neurology, Psychiatric |
| Therapuetic Areas: | Neurology, Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 65 - Any |
| Updated: | 2/7/2019 |
| Start Date: | February 2006 |
| End Date: | August 2012 |
Hospital to Home: Cognitively Impaired Elders/Caregivers
Aim 1. To compare across three hospital sites the effects on health and cost outcomes
observed by the following three interventions, each designed to enhance adaptation and
improve outcomes of hospitalized cognitively impaired elders and their caregivers:
1. augmented standard care (ASC) - standard hospital and, if referred, home care plus early
identification of CI during the patients' hospitalization by trained registered nurses
(RNs) with immediate feedback to patients' primary nurses, attending physicians and
discharge planners;
2. resource nurse care (RNC) - standard hospital and, if referred, home care plus early
identification of CI during the patient's hospitalization by trained RNs and hospital
care by RNs trained in the use of expert clinical guidelines developed to enhance the
care management of hospitalized cognitively impaired elders and to facilitate their
transition from hospital to home; or,
3. advanced practice nurse care (APNC) - standard hospital care plus transitional (hospital
to home) care substituting for standard home care and provided by APNs with advanced
training in the management of CI patients using an evidence-based protocol designed
specifically for this patient group and their caregivers.
[H1] We hypothesize that health and cost outcomes with APNC, a comprehensive intervention
designed to meet the unique needs of cognitively impaired older adults hospitalized for an
acute medical or surgical event and their caregivers will be associated, relative to health
and cost outcomes with ASC and RNC, with improvement in patient, caregiver and cost outcomes.
[H2] We hypothesize that improvements in patient, caregiver and cost outcomes observed for
the RNC group will be greater than those observed for the ASC group.
Aim 2. To compare within each site and over time, health and cost outcomes (identified in Aim
1) from patients treated with either ASC or RNC, both relatively lower intensity
interventions, with the outcomes of patients at the same site observed after switching to
APNC, a high intensity intervention.
[H3] We hypothesize that compared to patients receiving the ASC or the RNC interventions,
patients at the same site will have improved patient, caregiver and cost outcomes after the
site switches to APNC.
[H4] We hypothesize that patient, caregiver and cost outcomes achieved by the groups
receiving APNC interventions at T1 and T2 will be similar.
observed by the following three interventions, each designed to enhance adaptation and
improve outcomes of hospitalized cognitively impaired elders and their caregivers:
1. augmented standard care (ASC) - standard hospital and, if referred, home care plus early
identification of CI during the patients' hospitalization by trained registered nurses
(RNs) with immediate feedback to patients' primary nurses, attending physicians and
discharge planners;
2. resource nurse care (RNC) - standard hospital and, if referred, home care plus early
identification of CI during the patient's hospitalization by trained RNs and hospital
care by RNs trained in the use of expert clinical guidelines developed to enhance the
care management of hospitalized cognitively impaired elders and to facilitate their
transition from hospital to home; or,
3. advanced practice nurse care (APNC) - standard hospital care plus transitional (hospital
to home) care substituting for standard home care and provided by APNs with advanced
training in the management of CI patients using an evidence-based protocol designed
specifically for this patient group and their caregivers.
[H1] We hypothesize that health and cost outcomes with APNC, a comprehensive intervention
designed to meet the unique needs of cognitively impaired older adults hospitalized for an
acute medical or surgical event and their caregivers will be associated, relative to health
and cost outcomes with ASC and RNC, with improvement in patient, caregiver and cost outcomes.
[H2] We hypothesize that improvements in patient, caregiver and cost outcomes observed for
the RNC group will be greater than those observed for the ASC group.
Aim 2. To compare within each site and over time, health and cost outcomes (identified in Aim
1) from patients treated with either ASC or RNC, both relatively lower intensity
interventions, with the outcomes of patients at the same site observed after switching to
APNC, a high intensity intervention.
[H3] We hypothesize that compared to patients receiving the ASC or the RNC interventions,
patients at the same site will have improved patient, caregiver and cost outcomes after the
site switches to APNC.
[H4] We hypothesize that patient, caregiver and cost outcomes achieved by the groups
receiving APNC interventions at T1 and T2 will be similar.
Cognitive impairment (CI) is a major health problem complicating the care of increasing
numbers of older adults hospitalized for an acute medical or surgical condition. Dementia and
delirium, the most common causes of CI among these elders, is associated with higher
mortality rates, increased morbidity and higher health care costs. A growing body of science
suggests that these patients and their caregivers are particularly vulnerable to systems of
care that either do not recognize or ignore their needs. The consequences are devastating for
the patients and their caregivers and add tremendous burden to hospital staffs coping with a
severe shortage of nurses. For these reasons, the Institute of Medicine identified improved
care management of this patient group as a national priority for action. Unfortunately,
little evidence is available to guide optimal care of this patient group or to address the
unique needs of their caregivers. Collectively, available evidence suggests that these
patients may benefit from interventions aimed at improving management of CI, comorbid
conditions or both but the exact nature and intensity of intervention needed to effectively
and efficiently improve their outcomes and those of their caregivers is not known. Thus, the
timing is excellent for rigorous research aimed at identifying care management strategies
that will result in high quality, cost-effective outcomes for this challenging patient group
and their caregivers.
numbers of older adults hospitalized for an acute medical or surgical condition. Dementia and
delirium, the most common causes of CI among these elders, is associated with higher
mortality rates, increased morbidity and higher health care costs. A growing body of science
suggests that these patients and their caregivers are particularly vulnerable to systems of
care that either do not recognize or ignore their needs. The consequences are devastating for
the patients and their caregivers and add tremendous burden to hospital staffs coping with a
severe shortage of nurses. For these reasons, the Institute of Medicine identified improved
care management of this patient group as a national priority for action. Unfortunately,
little evidence is available to guide optimal care of this patient group or to address the
unique needs of their caregivers. Collectively, available evidence suggests that these
patients may benefit from interventions aimed at improving management of CI, comorbid
conditions or both but the exact nature and intensity of intervention needed to effectively
and efficiently improve their outcomes and those of their caregivers is not known. Thus, the
timing is excellent for rigorous research aimed at identifying care management strategies
that will result in high quality, cost-effective outcomes for this challenging patient group
and their caregivers.
Inclusion Criteria:
- Age >= 65 and older
- Speaks English
- Resides within 30 miles of admitting hospital site
- Admitted from home to one of three hospital sites
- a documented history of pre-existing dementia in their medical records or pre-screen
positive for cognitive impairment using our Pre-Screen Process.
- a primary caregiver (knowledgeable informant), defined as the spouse, family member,
partner or friend, who will provide support following discharge to home and is
reachable by telephone.
Exclusion Criteria:
- End Stage Disease
- Active untreated substance abuse or psychiatric conditions
- Primary cancer diagnosis (active treatment)
We found this trial at
3
sites
3400 Spruce St
Philadelphia, Pennsylvania 19104
Philadelphia, Pennsylvania 19104
(215) 662-4000
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