Population Health Approach to Optimizing and Deprescribing Medications in Older Adults
试验速览
- 阶段
- 不适用
- 状态
- Enrolling By Invitation
- 入组人数
- 100
- 试验地点
- 2
- 主要终点
- Number of all-cause hospitalizations
研究概览
简要总结
This randomized controlled pragmatic pilot study examines the feasibility and acceptability of a population health-based deprescribing intervention that leverages a polypharmacy risk prediction model. It includes four arms (2 intervention and 2 control arms) and uses a parallel arm study design.
详细描述
This pilot clinical trial will examine the feasibility and acceptability of a medication management intervention that uses risk stratification to identify older adults (including older adults with Mild Cognitive Impairment or Alzheimer's Disease and Related Dementias) at greatest risk for polypharmacy-related adverse events. The intervention will use a risk prediction model to identify potential study participants for inclusion and enroll them and their care partners into a polypharmacy clinic. The study will stratify patients by cognitive impairment status. The risk prediction model includes variables such as: age, sex, recent healthcare encounters, current and past medications, current and past lab tests, current and past diagnoses.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 65 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients will be invited to enroll in the study if they are in the top decile of risk selected by a risk prediction model of polypharmacy-related adverse events. The risk prediction model includes variables such as: age, sex, recent healthcare encounters, current and past medications, current and past lab tests, current and past diagnoses.
- •65 years of age or older
- •Have a primary care clinician within the Cedars-Sinai Health System who uses MyCSLink (electronic health record used by Cedars-Sinai).
- •Part of a Cedars-Sinai Health System population health registry (e.g., enrolled in an Accountable Care Organization, Medicare Advantage plan, or Primary Care First program)
- •Diagnosis of Mild Cognitive Impairment or Dementia at baseline (for one intervention group) on the problem list
- •Exclusion criteria include:
- •Patients for whom there is an active substance use disorder (defined by a physician) and thus for whom the intervention may not be appropriate
- •Patients with an organ transplant
- •Visits with a Cedars-Sinai Medical Center pharmacist for a polypharmacy consult within the last 6 months
- •Patients who previously indicated in the EHR that they wish to opt out of participating in research studies.
- •Patients enrolled in CS360, a program for highly complex medical patients, who already receive polypharmacy services.
排除标准
- 未提供
结局指标
主要结局
Number of all-cause hospitalizations
时间窗: 12 months after enrollment
Number of all-cause inpatient visits (including observation visits) 12 months after enrollment.
次要结局
- Total number of medications(Baseline, 12 months)
- Total number of potentially inappropriate medications(Baseline, 12 months)
- Number of medications with a dose reduction >10% over 12 months(12 months)
- Number of medications discontinued for 90 days or more which are re-prescribed(Baseline, 12 months)
- Number of times per day the patient is taking medications(Baseline, 12 months)
- Number of potential prescribing omissions (PPOs) based on the STOPP/START criteria(12 months)
- Number of drug-related problems(Baseline, 12 months)
- Number of potential pharmacy recommendations(Baseline, 12 months)
- Change in risk prediction model score(12 months)
研究者
Michelle Keller
Research Scientist I
Cedars-Sinai Medical Center