According to a controlled study from researchers from the Indianapolis-based Regenstrief Institute and the Indiana University School of Medicine, neither screening for cognitive impairment nor screening, followed by computerized alerts to the healthcare team improved patient outcomes. The controlled study screened 998 older adults for cognitive impairment within 48 hours of admission to the hospital. Approximately 40 percent were found to have cognitive impairment and were enrolled in the study.
“Our study determined that screening for cognitive impairment and providing information to physicians on the best care for patients with cognitive impairment is not the solution to improving care that we seek. We need to consider ways to tackle the difficult task of altering physician behavior,” Malaz Boustani, M.D., a Regenstrief Institute investigator and associate professor of medicine at the Indiana University School of Medicine, said in a statement.
According to the researchers, 40 percent of hospitalized older adults have cognitive impairment and six out of 10 of these cases are unrecognized. Screening, Boustani says, is not enough. “If the next step after screening is computerized reminders, we also found that these reminders need to be personalized to both the physician and the patient,” he added.
The study, “Enhancing Care for Hospitalized Older Adults With Cognitive Impairment: A Randomized Controlled Trial” appears in the May 2012 issue of the Journal of General Internal Medicine.
In the study, half of those with cognitive impairment received routine care. Physicians treating the other patients with cognitive impairment received alerts through an electronic medical record system. These alerts advised the physician of the cognitive impairment diagnosis, recommended consultation with a geriatrician, suggested discontinuation of physical restraints, and also advised that the physician not prescribe anticholinergic drugs. The simple computerized alerts did not significantly change physician behavior, according to the researchers. Referrals for geriatric consultation did not increase. Use of physical restraints did not diminish.
The study findings indicate the combination of screening plus computerized alerts had no impact on health outcomes, did not decrease mortality, and did not improve recognition of cognitive impairment at hospital discharge.