Optimizing Prescribing Decisions for Hospitalized Older Adults With Chronic Conditions

University of Pittsburgh

Status: Enrolling

Conditions: Prescribing Decisions; Geriatrics; Hypertension; Diabetes; Multimorbidity

Treatments: Other: Clinical Decision Framework for Managing older adults' chronic conditions during hospitalization.

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT06605807

K76AG074878 (U.S. NIH Grant/Contract)

STUDY24070027

Details and patient eligibility

About

The goal of this pilot clinical trial is to learn if providing a clinical decision framework for managing older adults chronic conditions during hospitalization to inpatient clinicians improves clinicians' ability to individualize chronic condition prescribing decisions for hospitalized older adults (65 and older). The main questions it aims to answer are:

• Will the clinical decision framework lead to clinicians having greater confidence to individualize discharge prescribing?
• Will clinicians using the framework discharge make fewer changes to hospitalized older adults with home diabetes and hypertension medications than they did prior to receiving the framework?
• Will older adult patients of participating clinicians will report fewer gaps in understanding of medication changes after the clinician is exposed to the framework?

Researchers will compare participating clinician survey responses and prescribing records from before and after an educational session presenting the clinical decision framework.

Participants will be asked to

• Attend a one-time educational session on the clinical decision framework
• Complete 2 electronic surveys, one before and one following the educational session.
• Agree for researchers to contact their patients, in order for patients to complete a one-time phone survey about changes made to home medications during hospitalization and quality of communication from the hospital team.

Enrollment: 150 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Clinician Participants:

Inclusion Criteria:

1. Attending clinicians who practice on the general medicine or hospital medicine service at UPMC Presbyterian, UPMC Montefiore, UPMC Shadyside, UPMC Mercy, or UPMC Magee-Women's Hospital campuses.
2. Practicing on the general medicine or hospital medicine service. This population may include physicians with training in general internal medicine, hospital medicine, family practice, internal medicine subspecialities, as well as advance practice clinicians.

Exclusion Criteria:

1. Anticipating leaving current clinical position within next 3 months
2. Less than 4 weeks of inpatient attending service scheduled within 3 months of recruitment

Patient Participants:

Inclusion Criteria:

1. Adult aged 65 years or older who are hospitalized under the care of a participating clinician and discharged home.
2. Eligible patients must recieve at least one cardiometabolic medication change at hospital discharge (can include new medication starts, stops, or dose changes). Cardiometabolic medications include any class of antihypertensive, lipid lowering, anti-platelet, or glucose lowering medications regardless of indication for use.

Exclusion Criteria:

1. Incapacity for informed consent / unable to answer survey questions due to cognitive impairment
2. Enrolled in hospice care

Trial design

Primary purpose: Health Services Research

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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150 participants in 1 patient group

Clinician Participants

Experimental group

Description:

All clinician participants will undergo the same intervention, an educational session providing a clinical decision framework for managing older adults' chronic conditions during hospitalization.

Treatment:

Other: Clinical Decision Framework for Managing older adults' chronic conditions during hospitalization.