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.
Adapting the Shed-MEDS Deprescribing Intervention to Dementia Care in Assisted Living
Partners: Abe’s Garden Assisted Living Facility, US Deprescribing Research Network
Principal Investigator: Jennifer Kim, DNP, GNP-BC, GS-C
Funding Source: NIH/NIA
Clinical Trials Registration Number: NCT05956665
Description: This National Institutes of Health & Aging funded single-arm, repeated-measures within-subjects pilot will evaluate the feasibility of implementing a person-centered deprescribing intervention (Shed-MEDS) adapted for persons with dementia residing in a memory care assisted living facility. The goal of the intervention is to safely deprescribe unnecessary medications while maintaining quality of life for persons with dementia. We will evaluate the feasibility by measuring family/surrogate and primary prescriber acceptance of deprescribing recommendations. Effectiveness will be measured by the total number of medications at 90-day follow up as compared to baseline. Residents’ quality of life will be assessed at multiple timepoints with a standardized questionnaire.
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:
Project Director: Sandra Simmons, PhD
Funding Source: Tennessee Department of Health – Healthcare Resiliency Program
Description: The Nursing Practice Transformation Initiative will implement focused strategies to mitigate the impact of the ongoing nursing shortage while also addressing social determinants of health (SDoH). The implementation and evaluation of alternative nursing care models that include SDoH processes will provide valuable information for state nursing leaders and other healthcare facilities facing similar staffing challenges and related concerns about equitable healthcare access and quality for all Tennesseans. Quality improvement methodologies will guide the implementation and evaluation of alternative models of nursing care on patient safety, care quality and health equity metrics as well as nurse workload, job satisfaction and retention. To safely evaluate alternative nursing care models prior to implementation, we will apply a systems engineering approach called Discrete Event Simulation (DES). Project Lead, Dr. Sandra Simmons PhD, is also currently leading an Agency for Healthcare Research and Quality (AHRQ) study utilizing DES for specific hospital units. The proposed project will expand the application of DES throughout the main adult hospital to inform alternative nursing care models that improve the precision of staffing allocations to meet hospitalized patients’ clinical care needs and support routine screening for SDoH. Additionally, the initiative will include screening and responding to social drivers of health (SDoH) to meet the needs of underserved groups. SDoH screening will extend to discharge care coordination clinics to further facilitate social support services.
Providing Safe Care to older Hospitalized Patients through Discrete Event Simulation Modeling
Funding Source: Agency for Healthcare Research and Quality
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.
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: AgeWell Middle Tennessee (formerly 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.