Improve inpatient, age-friendly care by implementing age-friendly EBPs within the inpatient hospital setting at VAMCs in VISNs 4, 5, 6, and 8 with Veterans 65+years old. Other
Conditions
Interventions
iSAGE will be implementing 3 age-friendly, evidence-based practices in VAMC hospital settings:
1. Eliminating Medications through Patient OWnership of End Results (EMPOWER) is a deprescribing interve
Sponsors
United States Department of Veterans Affairs
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: Veterans are eligible for inclusion if they are: 1. Inpatients admitted to one of the VAMCs in VISNs 4, 5, 6, and 8* participating in iSAGE implementation 2. Aged 65+ years 3. Meet EBP-specific inclusion criteria 3.1. EMPOWER: 1) Receiving one or more medication classes targeted by EMPOWER brochures prior to or during inpatient admission prescribed by VA or non-VA provider; and 2) not enrolled in hospice 3.2. TAP-H: 1) Diagnosis of dementia (using ICD-10 codes and dementia-specific medications); and 2) caregiver aged 18+ willing to participate (in-person or virtually), identified by CPRS facesheet 3.3. SP: 1) Admitted to an inpatient general, vascular, or orthopedic surgical service *or* to a non-surgical service with new surgery consult for general, vascular, or orthopedic surgery; AND 2) RAI=37 *or* one of 6 Preoperative Acute Serious Conditions (PASC) *or* admission to hospital from a non-home environment (e.g., SNF) *EBPs being implemented at participating VAMCs: VISN 4: Altoona (EM, TAP), Butler (EM, TAP), Coatesville (EM, TAP), Erie (EM, TAP), Lebanon (EM, TAP), Philadelphia (EM, TAP, SP), Pittsburgh (EM, TAP, SP), & Wilkes-Barre (EM, TAP), PA; Wilmington, DE (EM, TAP) VISN 5: Baltimore, MD (EM, TAP); Martinsburg, WV (EM, TAP); Washington, DC (EM, TAP) VISN 6: Richmond, VA (SP) VISN 8: Miami (EM, TAP, SP), Bay Pines (EM, TAP, SP), Gainesville (EM, TAP, SP), Tampa (EM, TAP, SP), West Palm Beach (EM, TAP), & Orlando, FL (EM, TAP, SP)
Exclusion criteria
Exclusion criteria: 1. Receipt of hospice care or being in long-term nursing home care 2. Veterans with severe mental illness will be excluded from EMPOWER 3. Veterans without a caregiver will be excluded from TAP-H
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| 1. Implementation Outcome – Reach: Reach will be measured as the number and proportion of eligible Veterans enrolled in each evidence-based program (EBP) over time 2. Process Outcome – 4Ms Template Completion: Completion of the 4Ms note template will be measured for Veterans receiving each intervention at the time of care delivery 3. Effectiveness Outcomes – EBP-Specific: 3.1. EMPOWER: Cessation of targeted medications will be measured after hospital discharge 3.2. Surgical Pause: Reduction in observed-to-expected mortality will be measured among high-risk patients with expected mortality greater than 2.5% at the time of surgical outcome assessment 3.3. TAP-H: Unplanned hospital readmissions will be measured within the post-discharge period | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Cross-EBP Secondary Effectiveness Outcome: Days elsewhere than home (DEH) will be measured for Veterans receiving each EBP during the follow-up period 2. EBP-Specific Secondary Effectiveness Outcomes: 2.1. EMPOWER: 2.1.1. Medication dose reduction will be measured following discharge 2.1.2. Reduced falls will be measured during the post-intervention monitoring period 2.2. Surgical Pause: 2.2.1. Quality of goal clarification documents (“What Matters” conversations) will be assessed at the time of documentation 2.2.2. Hospital and ICU lengths of stay will be measured post-consultation 2.2.3. Perioperative complications will be measured during the surgical recovery period 2.3. TAP-H: 2.3.1. Caregiver burden, including “time on duty,” will be measured during the caregiving period 2.3.2. Veteran readmission rates and skilled nursing facility utilization will be measured during the post-discharge period | — |
Countries
United States of America
Contacts
Public ContactTanisha Dicks
Outcome results
None listed