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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Neuroscience of Aging Review Committee (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; LaSalvia, Mary T; Naidus, Elliot et al. (2017) Antipsychotics and the Risk of Aspiration Pneumonia in Individuals Hospitalized for Nonpsychiatric Conditions: A Cohort Study. J Am Geriatr Soc 65:2580-2586
Herzig, Shoshana J; Marcantonio, Edward R (2016) Reply to ""Antipsychotics: Mortality Risk Themselves?"" J Am Geriatr Soc 64:2400
Herzig, Shoshana J; Schnipper, Jeffrey L; Doctoroff, Lauren et al. (2016) Physician Perspectives on Factors Contributing to Readmissions and Potential Prevention Strategies: A Multicenter Survey. J Gen Intern Med 31:1287-1293
Herzig, Shoshana J (2016) Capsule Commentary on Scales et al., Unintentional Continuation of Medications Intended for Acute Illness After Hospital Discharge: A Population-Based Cohort Study. J Gen Intern Med 31:224
Herzig, Shoshana J; Rothberg, Michael B; Guess, Jamey R et al. (2016) Antipsychotic medication utilization in nonpsychiatric hospitalizations. J Hosp Med 11:543-9
Herzig, Shoshana J (2016) Opening the black box of inpatient opioid prescribing. J Hosp Med 11:595-6
Sokol-Hessner, Lauge; White, Andrew A; Davis, Katherine F et al. (2016) Interhospital transfer patients discharged by academic hospitalists and general internists: Characteristics and outcomes. J Hosp Med 11:245-50
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
Ronan, Matthew V; Herzig, Shoshana J (2016) Hospitalizations Related To Opioid Abuse/Dependence And Associated Serious Infections Increased Sharply, 2002-12. Health Aff (Millwood) 35:832-7
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

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