The broad goal of the work in this application is to improve the care of hospitalized older adults through safer medication prescribing practices. More specifically, the objectives of this proposal are to define current usage patterns and risks of sedating medications in hospitalized patients, and use this knowledge to develop an intervention to promote safer prescribing. This work will be carried out in two phases. First, two large existing hospital data repositories will be used in a parallel and complementary fashion to investigate current usage patterns of sedating medications and their association with specific hypothesized risks - hospital-acquired pneumonia and in-hospital falls - in two large cohorts of hospitalized patients. These analyses will employ advanced epidemiologic methods for confounder control, including propensity score and instrumental variable approaches. In the second phase of this work, the information gained from the first phase will be combined with existing knowledge related to safe prescribing practices to develop and conduct a pilot study of a computerized decision support (CDS) tool that bundles prescribing suggestions with specific preventive interventions for those at highest risk. The impact of this CDS tool on safe prescribing practices will be investigated, and this information will be used to inform development of a multi-site, cluster randomized controlled trial as part of a future R01 submission. Through these analyses, her planned coursework, and strong mentorship, the candidate, Dr. Shoshana Herzig, will advance her methodological skills in pharmacoepidemiologic analysis and aging research. She will also further develop her ability to translate research findings into interventions that will successfully impact the clinical care of older hospitalized patients, and learn the methods necessary to rigorously measure that impact. Taken together, this multi-faceted proposal will facilitate Dr. Herzig's development into an independent patient-oriented investigator in geriatric pharmacoepidemiology.

Public Health Relevance

Medications are the leading cause of significant, unintended harm to hospitalized patients, and older patients are particularly susceptible to such medication-related harm. The proposed studies will lead to a better understanding of inpatient use of sedating medications - a class of medications commonly implicated in adverse events - the associated risks, and the development of interventions to promote safer use. This work is a crucial step towards reducing unintended harm to older hospitalized patients.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Mentored Patient-Oriented Research Career Development Award (K23)
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National Institute on Aging Initial Review Group (NIA)
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Salive, Marcel
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Beth Israel Deaconess Medical Center
United States
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Herzig, Shoshana J; Nardino, Robert J (2016) Reconsidering a Common Practice: In-Hospital Use of PPIs. J Gen Intern Med 31:361-2
Herzig, Shoshana J; Marcantonio, Edward R (2016) Reply to ""Antipsychotics: Mortality Risk Themselves?"" J Am Geriatr Soc 64:2400
Marshall, John; Herzig, Shoshana J; Howell, Michael D et al. (2016) Antipsychotic utilization in the intensive care unit and in transitions of care. J Crit Care 33:119-24
Herzig, Shoshana J; Rothberg, Michael B; Guess, Jamey R et al. (2016) Antipsychotic Use in Hospitalized Adults: Rates, Indications, and Predictors. J Am Geriatr Soc 64:299-305
Herzig, Shoshana J (2015) Growing concerns regarding long-term opioid use: the hospitalization hazard. J Hosp Med 10:469-70
Allen-Dicker, Joshua; Herzig, Shoshana J; Kerbel, Russell (2015) Global payment contract attitudes and comprehension among internal medicine physicians. Am J Manag Care 21:e474-9
Herzig, Shoshana J; Guess, Jamey R; Feinbloom, David B et al. (2015) Improving appropriateness of acid-suppressive medication use via computerized clinical decision support. J Hosp Med 10:41-5
Breu, Anthony C; Herzig, Shoshana J (2014) Differentiating DNI from DNR: combating code status conflation. J Hosp Med 9:669-70
Herzig, Shoshana J; Doughty, Christopher; Lahoti, Sourabh et al. (2014) Acid-suppressive medication use in acute stroke and hospital-acquired pneumonia. Ann Neurol 76:712-8
Breu, Anthony C; Allen-Dicker, Joshua; Mueller, Stephanie et al. (2014) Hospitalist and primary care physician perspectives on medication management of chronic conditions for hospitalized patients. J Hosp Med 9:303-9

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