Delirium is a common, serious, and potentially preventable problem for hospitalized older patients, with occurrence rates of 25-60 percent, hospital mortality rates of 25-33 percent, and annual Medicare expenditures of over $4 billion (1994). Our previous study, the Delirium Prevention Trial, documented the effectiveness of a multi-component targeted intervention strategy for substantially reducing the risk of developing delirium during hospitalization, compared with usual care. The overall objectives of the current renewal application are to extend the analyses to examine cost-effectiveness, secondary and long-term outcomes, and effects of adherence on intervention effectiveness. These investigations will more fully establish the effectiveness of our intervention strategy, including its overall cost-effectiveness and the lasting nature of the benefits. The proposed study will involve the 852 subjects enrolled into the Delirium Prevention Trial, consisting of 426 matched pairs of intervention and usual care subjects. For the current proposal, we will supplement the data collected during the clinical trial, with one year of follow-up data from: 1) telephone interviews; 2) medical record reviews; 3) health care utilization and charge data from Medicare; 4) Connecticut Long-Term Care Registry; 5) hospital costs from the Hospital Information System; and 6) National Death Index. Using these data sources, cost-effectiveness ratios for the intervention vs. usual care groups will be estimated, using standard and multivariable approaches. The impact of the intervention on secondary and long-term outcomes (e.g., functional and cognitive status, depression, self-rated health, mortality, nursing home placement, and health care utilization) will be examined using standard and longitudinal repeated measures methods. Finally, the impact of adherence on intervention effectiveness will be estimated using bivariate and multivariable approaches. Strengths of the proposed project include the considerable progress and preliminary work, the innovative nature of the intervention strategy and of the analytic approaches in this matched clinical trial, the expertise and experience of the analytic team, and the supportive research environment. This study is highly significant for the promise it holds for demonstrating the effectiveness and cost-effectiveness of the Delirium Prevention Trial strategy, which may ultimately yield substantial health and quality of life benefits for the geriatric population at large.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
2R01AG012551-06
Application #
6131784
Study Section
Special Emphasis Panel (ZRG1-SNEM-4 (01))
Program Officer
Buckholtz, Neil
Project Start
1995-08-10
Project End
2004-06-30
Budget Start
2000-07-01
Budget End
2001-06-30
Support Year
6
Fiscal Year
2000
Total Cost
$370,571
Indirect Cost
Name
Yale University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
082359691
City
New Haven
State
CT
Country
United States
Zip Code
06520
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Agostini, Joseph V; Zhang, Ying; Inouye, Sharon K (2007) Use of a computer-based reminder to improve sedative-hypnotic prescribing in older hospitalized patients. J Am Geriatr Soc 55:43-8
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Leslie, Douglas L; Zhang, Ying; Bogardus, Sidney T et al. (2005) Consequences of preventing delirium in hospitalized older adults on nursing home costs. J Am Geriatr Soc 53:405-9
Fick, Donna M; Kolanowski, Ann M; Waller, Jennifer L et al. (2005) Delirium superimposed on dementia in a community-dwelling managed care population: a 3-year retrospective study of occurrence, costs, and utilization. J Gerontol A Biol Sci Med Sci 60:748-53
Moody-Ayers, Sandra Y; Stewart, Anita L; Covinsky, Kenneth E et al. (2005) Prevalence and correlates of perceived societal racism in older African-American adults with type 2 diabetes mellitus. J Am Geriatr Soc 53:2202-8
Leslie, Douglas L; Zhang, Ying; Holford, Theodore R et al. (2005) Premature death associated with delirium at 1-year follow-up. Arch Intern Med 165:1657-62
Inouye, Sharon K; Leo-Summers, Linda; Zhang, Ying et al. (2005) A chart-based method for identification of delirium: validation compared with interviewer ratings using the confusion assessment method. J Am Geriatr Soc 53:312-8

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