PROJECTS RELATED TO MEDICATION REDUCTION IN OLDER PATIENTS:
The US Deprescribing Research Network (USDen)
Partners: University of California San Francisco and Johns Hopkins
Funding Source: National Institute of Aging (R24)
Description: The US Deprescribing Research Network (USDeN) is a community of people united by a shared interest in improving research on deprescribing for older adults. Funded by the National Institute on Aging, USDeN offers pilot grants, investigator development and education, an annual meeting, support for junior investigators, assistance with stakeholder engagement, resources for deprescribing research, and more including opportunities for collaboration and building community. Please visit their website at https://deprescribingresearch.org/ and register for their kickoff webinar on December 3, 2019 to learn more.
A Randomized Controlled Trial to Deprescribe for Older Patients with Polypharmacy Transferred from the Hospital to Skilled Nursing Facilities (Shed MEDS)
Project Co-Principal Investigators: Sandra Simmons, PhD and Eduard Vasilevskis, MD
Funding Source: NIH/NIA
Clinical Trials Registration Number: NCT02979353
Description: This National Institutes of Health & Aging funded randomized, controlled trial evaluates the effects of an intervention to reduce exposure to medications among hospitalized older adults discharged to skilled nursing facilities (SNFs). The goal of the intervention is to safely deprescribe medications, as defined by dose reductions and stopped medications, based on a combination of clinical criteria and patient preferences. We evaluate the effects of the intervention on the total number of medications prescribed to patients at hospital and SNF discharge and at home 90-days after SNF discharge along with the prevalence of eight geriatric syndromes, medication adherence, and health status.
Drug Reduction in Older Patients The DROP Trial
Project Co-Principal Investigators: Amanda Mixon, MD and Sandra Simmons, PhD
Funding Source: Veterans Affairs (VA) Office of Research and Development
Clinical Trials Registration Number: NCT03722017
Description: This Veterans Affairs (VA) Office of Research and Development funded randomized, controlled trial will evaluate the effects of an intervention to reduce exposure to medications among hospitalized older adult Veterans discharged to skilled nursing facilities (SNFs). The goal of the intervention is to safely deprescribe medications, as defined by dose reductions and stopped medications, based on a combination of clinical criteria and Veterans preferences. We will evaluate the effects of the intervention on the total number of medications prescribed to Veterans at hospital and SNF discharge and at home at 7 and 90-days after SNF discharge along with the prevalence of eight geriatric syndromes, medication adherence, and health status. The project team will consist of dedicated staff to conduct patient consent, assessments and intervention protocols.
PROJECTS RELATED TO HOSPITAL SAFETY FOR OLDER PATIENTS:
Providing Safe Care to older Hospitalized Patients through Discrete Event Simulation Modeling
Funding Source: Agency for Healthcare Research and Quality
9/01/2019 - 06/30/2024
Description: Many hospital patients, particularly older patients, are dependent on staff for assistance with activities of daily living (ADL) such as walking and toileting. Assistance with these activities is time-consuming for staff, and evidence suggests that ADL assistance is not consistently provided in hospitals. This inconsistent ADL care is often associated with adverse events, particularly falls, with 30-60% of hospital falls related to patients’ attempts to use the bathroom. There is evidence that consistent toileting and mobility assistance can prevent falls, but barriers related to staffing and the complex hospital work environment make it difficult to provide this care consistently in daily acute care practice.
The National Academy of Medicine has identified a systems-engineering approach called Discrete Event Simulation (DES) as a method to improve the quality and efficiency of health care. This approach has been used for decades in other industries and more recently applied to healthcare settings. Discrete Event Simulation mathematically models multiple work parameters that define a care setting, such as the time to provide an episode of care, and predicts the ability of staff within that setting to provide care at different points in time based on other competing demands and care requirements. Sensitivity and predictive analyses can be used to examine how changes to the system, such as different staff schedules or order of care routines, affect and improve care delivery thus facilitating more efficient management.
This investigative team has applied DES to the nursing home setting to identify staffing needs to provide care based on a range of resident ADL dependencies and staffing resources. However, this DES methodology has not been applied to the acute care setting, where many older patients need similar ADL care services and also are at risk for falls. Thus, the purpose of the proposed study is to apply DES to the hospital setting focused on units that care for large numbers of older patients with ADL dependencies.
This study will produce a novel technology that hospital providers may use to efficiently manage medical units by experimenting with innovative approaches to improve ADL care prior to more expensive efforts to implement and test interventions in actual practice. This technology will be first developed and tested in an Acute Care for the Elderly (ACE) unit. However, the degree to which the model accurately describes care in two other diverse hospital units will be tested in preparation for disseminating the model to other units and hospitals via a web-based simulation tool.
Department of Health and Human Services - Administration For Community Living Alzheimer's Disease Program Initiative
Project Role: Program Evaluation Sub-Contract
6/01/2019 - 05/31/2022
Description: The Tennessee Commission on Aging and Disability (TCAD), in partnership with the state’s Area Agencies on Aging and Disability, Vanderbilt University Medical Center for Quality Aging, and other stakeholders will expand and implement a dementia-capable system across the State. The goal of the project is to promote the development and expansion of a dementia-capable home and community-based service (HCBS) system in Tennessee. The objectives are: 1) expand and sustain a dementia-capable HCBS system that includes Single Entry Point and streamlined access for people with Alzheimer's disease and related dementias (ADRD) and their caregivers statewide in Tennessee; 2) Ensure access to a comprehensive, sustainable set of quality services/interventions that are dementia-capable and provide innovative services to the population with dementia and their caregivers; 3) Implement an in-home music-therapy based intervention for at least 180 individuals in home and community based settings.
The Middle Tennessee Geriatric Workforce (GWEP)
Project Co-Principal Investigators: Dr. James Powers, MD
Academic and Medical Center Partners: Vanderbilt School of Nursing, Nashville Veteran Administration and Meharry Medical College
Community Agency Partners: Council on Aging of Middle Tennessee, Richland Place Health Center, Honoring Choices, Tennessee, Knowles Home Assisted Living Facility and Alzheimer's
Funding Source: HRSA
Description: The Middle TN GWEP combines the expertise of Vanderbilt University Medical Center, Vanderbilt School of Nursing, the Nashville Veterans Administration, Meharry Medical College and numerous community agencies dedicated to the welfare of older Tennesseans. Middle TN GWEP partners have a history of collaboration to address critical needs in geriatric healthcare. The work plan includes 11 quality improvement projects within six topic areas: (1) Alzheimer’s Disease and Related Dementias (ADRD) caregiver support and education; (2) Patient and provider education on substance use disorder and screening for risk of opioid misuse (3) Advance Care Planning within a Medical-Legal Partnership and public outreach and education on advance directives with Honoring Choices® Tennessee; (4) Reduction of potentially inappropriate medications among targeted patient populations; 5) Reduction of all-cause 30 – day hospital readmissions among targeted patient populations; and, (6) Increasing the number of Falls Risk Assessments.
Feeding Assistance for Persons with Dementia: Training Modules for Professional and Family Caregivers
Principal Investigator: Sandra Simmons, PhD
Funding Source: The Allen Foundation
Sub-Contract: Abe’s Garden
Description: The Allen Foundation funded the development and dissemination of a series of nutrition education and training videos for professional and family caregivers. Video content includes feeding assistance care techniques to encourage food and fluid intake among older adults with dementia. Techniques are evidence-based and designed to enhance independence in eating, dignity and choice. Researchers partner with local dementia care facility, Abe’s Garden, to develop and distribute the videos to dementia care providers within the community.