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: 9335221
• 负责人: SANDRA F SIMMONS
• 金额: $ 60.43万
• 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/9335221
• 关键词: Acute; Address; Adverse effects; Anti-Cholinergics; Area; Award; Body Weight decreased; 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; Link; Literature; Low Prevalence; Medicare; Monitor; Older Population; Outcome; Participant; Patient Preferences; Patients; Pharmaceutical Preparations; Pharmacists; Polypharmacy; Preparation; Prevalence; Protocols documentation; Provider; Publishing; Randomized Controlled Trials; Reporting; Safety; Services; Severities; Skilled Nursing Facilities; Standardization; Structure; Symptoms; Syndrome; Testing; United States Centers for Medicare and Medicaid Services; Universities; Urinary Incontinence; base; beneficiary; body system; experience; falls; follow-up; frailty; high risk population; improved outcome; indexing; innovation; intervention effect; medication compliance; novel; older patient; patient oriented; patient population; prospective; 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.

项目摘要 拟议的随机，对照试验将评估干预措施的影响以减少 住院的老年人的药物暴露于熟练的护士设施（SNF）。这 研究将在一家大学附属医院和14个SNF进行研究，以注册约1,300 五个项目年的参与者总数。出院到SNF的患者是最大的部分 医疗保险受益人被送往急诊后的护理服务，是丧失的尤其高风险群体 独立性和其他临床结果不佳。这个调查团队最近为 Medicare和Medicaid Services（CMS）创新奖，提供与 多药的患病率以及多药与老年综合症之间的关系（例如， 与跌倒有关的药物）在该患者人群中。基于这些数据，我们开发了一个结构化的 排除干预方案（“棚屋”）以及八个标准化筛查评估 老年综合症将在医院实施，并在SNF停留期间继续进行。目标的目标 干预措施是安全地描述药物，如降低剂量和停止药物所定义的药物， 基于临床标准和患者偏好的组合。我们对以患者为中心进行了试点测试 干预准备这项提案，并有希望结果。拟议的试验将评估效果 关于药物暴露，药物依从性，老年综合征和健康状况的干预措施 在从医院到SNF到家的整个护理过渡，包括SNF之后的90天随访期 释放。我们的总体假设是，在整个连续体的老年患者中减少药物 护理会对老年综合症产生有利的影响。