Clinical Decision Framework for Chronic Conditions in Older Adults

Overseen By Ella Hileman-Kaplan, BA

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Pittsburgh

Must be taking: Cardiometabolic medications

Disqualifiers: Cognitive impairment, Hospice care

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

150 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

The trial aims to determine if an educational tool, the Clinical Decision Framework, can assist doctors in making better medication decisions for older adults with chronic conditions like diabetes and hypertension during hospital stays. It examines whether doctors feel more confident and make fewer changes to patients' home medications. The trial also assesses if patients better understand their medication changes after doctors use the new tool. Clinicians involved practice in specific hospitals and often handle general or hospital medicine, while patients are adults 65 and older who experienced recent medication changes upon hospital discharge. As an unphased trial, this study offers patients the chance to contribute to innovative research that could enhance medication management for older adults.

Do I need to stop my current medications for this trial?

The trial does not specify if you need to stop your current medications. However, it involves changes to cardiometabolic medications (like those for blood pressure or diabetes) at hospital discharge, so discuss with your doctor.

What prior data suggests that this clinical decision framework is safe for managing older adults' chronic conditions?

Research has shown that clinical decision support systems, like the one in this trial, improve quality checks and user satisfaction. They also aid in managing heart, kidney, and metabolism-related conditions.

One study found that these systems help doctors make better prescribing choices, reducing inappropriate medication use in older adults. However, their impact on adverse drug reactions remains unclear.

Overall, these systems appear well-received and useful in guiding treatment decisions. The sources provided do not indicate any direct harm from using such a system. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it focuses on a new approach to managing chronic conditions in older adults during hospitalization. Unlike traditional methods, which often rely on generalized treatment plans, this approach provides a clinical decision framework tailored to the unique needs of older patients. By offering a structured educational session for clinicians, it aims to improve decision-making and outcomes specifically for this age group. This could lead to more personalized and effective care, ultimately enhancing the quality of life for older patients.

What evidence suggests that this clinical decision framework is effective for managing chronic conditions in older adults?

Research has shown that a clinical decision framework can enhance care for older adults with multiple long-term health issues. This trial involves clinician participants who will attend an educational session on this framework, based on guidelines from the American Geriatrics Society. These guidelines emphasize tailoring treatment options to each older patient's needs. Studies have demonstrated that decision aids help patients and doctors collaborate on informed health choices. This approach aims to simplify care and ensure that treatment aligns with patients' desires and needs. Although specific results from this trial are not yet available, the framework relies on proven methods for effectively managing chronic conditions. ^{2 6 7 8 9}

Who Is on the Research Team?

Timothy S Anderson, MD, MAS

Principal Investigator

University of Pittsburgh

Are You a Good Fit for This Trial?

This trial is for inpatient clinicians treating hospitalized older adults (65+) with chronic conditions like diabetes and high blood pressure. Clinicians must be willing to attend an educational session, complete surveys before and after the session, and allow researchers to survey their patients.

Inclusion Criteria

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

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 subspecialties, as well as advance practice clinicians

I am 65 or older, was hospitalized, and am now discharged home.

Exclusion Criteria

Anticipating leaving current clinical position within the next 3 months

Enrolled in hospice care

Less than 4 weeks of inpatient attending service scheduled within 3 months of recruitment

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Educational Session

Participants attend a one-time educational session on the clinical decision framework

1 day

1 visit (in-person)

Survey Completion

Participants complete 2 electronic surveys, one before and one following the educational session

1 week

Follow-up

Participants are monitored for changes in prescribing practices and patient understanding post-intervention

2 months

What Are the Treatments Tested in This Trial?

Interventions

• Clinical Decision Framework for Managing older adults' chronic conditions during hospitalization

Trial Overview The study tests a clinical decision framework aimed at helping clinicians personalize medication plans for elderly hospital patients with multiple chronic illnesses. It measures clinician confidence, changes in patient medications, and patient understanding of these changes.

How Is the Trial Designed?

Group I: Clinician Participants Experimental Treatment 1 Intervention

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

Who Is Running the Clinical Trial?

University of Pittsburgh

Lead Sponsor

Trials

1,820

Recruited

16,360,000+

National Institute on Aging (NIA)

Collaborator

Trials

1,841

Recruited

28,150,000+

Published Research Related to This Trial

In a pilot study involving 70 older adults with multiple chronic conditions, identifying patient healthcare priorities during routine visits led to fewer medications being added for those in the Patient Priorities Care (PPC) group compared to usual care (UC) patients.

Patients in the PPC group received more referrals to community services and aligned self-management tasks, indicating that incorporating patient priorities can enhance care decisions and better meet individual needs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility of Clinicians Aligning Health Care with Patient Priorities in Geriatrics Ambulatory Care. Freytag, J., Dindo, L., Catic, A., et al.[2021]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6464446/

Clinical Decision-Making for Older Patients With Multiple ... It follows the stepwise framework of clinical decision-making for patients with multiple chronic conditions that was laid out by the American Geriatrics Society ...

2. sciencedirect.com sciencedirect.com/science/article/pii/S0738399123003610

Supporting older patients in making healthcare decisions Current DAs can be used to support shared decision making with older patients when faced with treatment, screening or care decisions.

3. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2777860

Outcome Goals and Health Care Preferences of Older ... This cross-sectional study describes the outcome goals and health care preferences of older adults with multiple chronic conditions.

4. bmcgeriatr.biomedcentral.com bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-015-0136-7

Measured outcomes of chronic care programs for older adults The CCM framework includes six components: Community Resources and Policies; Health system organization; Self-Management Support; Decision ...

5. geriatricscareonline.org geriatricscareonline.org/ProductAbstract/Framework-for-Decision-making-for-Older-Adults/CL026

Framework for Decision-making for Older Adults with ... The Framework for Decision-making for Older Adults with Multiple Chronic Conditions translates The AGS Guiding Principles for the Care of Older Adults with ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7197748/

Chronic Disease Decision Making and 'What Matters Most' While decision aids (DAs) focus on trade offs by delineating options and outcomes, the robust outcome data necessary to create DAs for older ...

7. i-jmr.org i-jmr.org/2024/1/e58036

Benefits of Clinical Decision Support Systems for the ... Our findings show that CDSSs improved quality assurance and user satisfaction, and they provided clinical benefits in cardio-renal-metabolic ...

8. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2814211

Patient Priorities–Aligned Care for Older Adults With ... These findings suggest that aligning care with health priorities may help improve some important health outcomes for older adults.

9. academic.oup.com academic.oup.com/ageing/article/54/7/afaf206/8214134

Evaluating the role of clinical decision support systems in ... CDSS improved prescribing practices by reducing inappropriate medication use in older people. However, its impact on ADEs was less evident.