A Pilot Study of an RCT to Improve Infection Management in Advanced Dementia
Overview
- Phase
- Phase 2
- Intervention
- Not specified
- Conditions
- Dementia
- Sponsor
- Hebrew SeniorLife
- Enrollment
- 62
- Locations
- 1
- Primary Endpoint
- proportion of suspected infectious episodes for which antimicrobials were initiated appropriately
- Status
- Completed
- Last Updated
- 9 years ago
Overview
Brief Summary
To conduct a pilot study of cluster randomized clinical trial of an practice intervention to improve the quality of care for suspected lower respiratory and and urinary tract infections among 60 nursing home residents with advanced dementia living in 4 facilities (2 matched intervention/control pairs) for 12 months. We hypothesize that 1. In the intervention compared to the control facilities there will be a trend towards a greater proportion of infections for which antimicrobials were initiated appropriately, and 2. in the intervention compared to the control facilities there will be a trend towards higher proxy satisfaction with decision-making, fewer hospital transfers, and lower antimicrobial exposure.
Investigators
Susan Mitchell, MD
Senior Scientist
Hebrew SeniorLife
Eligibility Criteria
Inclusion Criteria
- •Resident eligibility criteria include: 1) Age \> 65, 2) Dementia, 3) Global Deterioration Scale score of 7,59 and 4) a proxy is available who can speak in English. Features of Global deterioration stage 7 include: profound memory deficits (cannot recognize family), total functional dependence, speech \< 5 words, incontinence, and inability to ambulate.
- •Eligibility criteria for providers in the intervention nursing homes include: Medical Doctor,a. nurse, nurse practitioner, physician assistant identified by a senior administrator as an individual who cares for residents with advanced dementia, and is
- •able to communicate in English because on-line course and algorithms are in English., and
- •over 21 years of age.
Exclusion Criteria
- •Residents with cognitive impairment due to causes other than dementia (e.g., head trauma) and in short-term, sub-acute SNFs will be excluded. -
Outcomes
Primary Outcomes
proportion of suspected infectious episodes for which antimicrobials were initiated appropriately
Time Frame: 12 months
The primary outcome will be the proportion of suspected infectious episodes for which antimicrobials were initiated appropriately defined by 2 factors: i. minimal clinical criteria to start antimicrobials are met based on consensus guidelines, ii. treatment was consistent with proxy preferences (based on proxy interview).
Secondary Outcomes
- hospital transfers(12 months)