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

Trial Summary

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 data supports the effectiveness of the treatment Clinical Decision Framework for Managing older adults' chronic conditions during hospitalization?

The research suggests that aligning healthcare decisions with patients' priorities can improve care for older adults with multiple chronic conditions, indicating that a decision framework focusing on patient priorities may be effective. ^{1 2 3 4 5}

How does this treatment for chronic conditions in older adults differ from other treatments?

This treatment is unique because it uses a clinical decision framework specifically designed for older adults with multiple chronic conditions, focusing on patient-centered care by aligning medical decisions with the patient's health priorities and preferences, rather than a one-size-fits-all approach. ^{6 7 8 9 10}

What is the purpose of this trial?

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.

Research Team

Timothy S Anderson, MD, MAS

Principal Investigator

University of Pittsburgh

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

References

1. England pubmed.ncbi.nlm.nih.gov

Can routine clinical data identify older patients at risk of poor healthcare outcomes on admission to hospital? [2022]

2. Australia pubmed.ncbi.nlm.nih.gov

Frailty status, timely goals of care documentation and clinical outcomes in older hospitalised medical patients. [2022]

3. England pubmed.ncbi.nlm.nih.gov

Decisional needs assessment of patients with complex care needs in primary care: a participatory systematic mixed studies review protocol. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Predictors of quality-of-care processes in geriatric assessment units: toward a better organizational framework. [2012]

5. United States pubmed.ncbi.nlm.nih.gov

Feasibility of Clinicians Aligning Health Care with Patient Priorities in Geriatrics Ambulatory Care. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

Clinical Decision-Making for Older Patients With Multiple Chronic Conditions: A Case-Based Exercise for Medical Students. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Planning for a Safe Discharge: More Than a Capacity Evaluation. [2021]

8. England pubmed.ncbi.nlm.nih.gov

Medical and moral considerations regarding complex medical decisions in older patients with multimorbidity: a compact deliberation framework. [2018]

9. United States pubmed.ncbi.nlm.nih.gov

Decision Making for Older Adults With Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity. [2020]

10. England pubmed.ncbi.nlm.nih.gov

Assessing the perspective of well-being of older patients with multiple morbidities by using the LAVA tool - a person-centered approach. [2021]