Aligning Hospital Admission Decisions with Health Priorities of People with Alzheimer's Disease and Related Dementias
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PROJECT SUMMARY People with Alzheimer's disease and related dementias are often hospitalized from the emergency department (ED) for conditions that can be treated in the outpatient setting. Such hospitalizations represent low-value care, defined as care that confers limited clinical benefit, may result in significant harms, and is inconsistent with patient preferences. The hospital setting is often disorienting and upsetting for people with dementia (PWD), and PWD have high risks of cognitive and functional decline after discharge. As such, ED admission decisions are central to the trajectories of PWD, yet ED-based strategies are lacking to reduce admissions of PWD for conditions that can be treated in the outpatient setting. The proposed research will test a shared decision-making intervention regarding ED admission of PWD who are identified via electronic health record data as at risk for low-value hospitalization. This K23 proposal is designed to provide Dr. Anita Chary, MD PhD, an emergency physician and anthropologist, with the training required to be a successful independent clinician-scientist dedicated to aligning emergency care with the health priorities of PWD and their care partners. The overarching goal of this project is to align ED admission decisions with the outcome goals and care preferences of PWD and their care partners, thereby reducing hospitalizations of PWD that are potentially harmful and undesired. The proposal innovatively integrates methods of implementation science and informatics. We will use principles of implementation science and human-centered design to adapt an evidence-based intervention that promotes shared decision-making about hospital admission between clinicians, ED patients with dementia, and their care partners (Aim 1). We will develop and test an electronic health record-based approach to identify PWD at risk of low-value hospitalization, derived from a patient-centered concept of low-value care (Aim 2). We will perform a pilot trial to assess the feasibility and acceptability of using the adapted intervention to help clinicians, care partners, and PWD identified using electronic health record data to arrive at shared decisions about hospital admission (Aim 3). As a junior faculty member at an institution with extensive support for early-stage investigators and robust infrastructure in healthcare innovation, Dr. Chary is in an ideal environment to successfully complete the proposed research and pursue advanced training to facilitate her transition to independent investigation. Dr. Chary's career development plan integrates didactic training, individualized learning, and mentored research in the areas of 1) implementation science, 2) informatics, and 3) clinical trials with PWD. This proposed award addresses critical gaps in reducing low-value care for PWD while cultivating Dr. Chary's ability to lead an independent research program focused on improving emergency care of PWD.
