The goal of this pilot clinical trial is to learn if providing a clinical decision framework for managing older adults chronic conditions during hospitalization to inpatient clinicians improves clinicians' ability to individualize chronic condition prescribing decisions for hospitalized older adults (65 and older). The main questions it aims to answer are: * Will the clinical decision framework lead to clinicians having greater confidence to individualize discharge prescribing? * Will clinicians using the framework discharge make fewer changes to hospitalized older adults with home diabetes and hypertension medications than they did prior to receiving the framework? * Will older adult patients of participating clinicians will report fewer gaps in understanding of medication changes after the clinician is exposed to the framework? Researchers will compare participating clinician survey responses and prescribing records from before and after an educational session presenting the clinical decision framework. Participants will be asked to * Attend a one-time educational session on the clinical decision framework * Complete 2 electronic surveys, one before and one following the educational session. * Agree for researchers to contact their patients, in order for patients to complete a one-time phone survey about changes made to home medications during hospitalization and quality of communication from the hospital team.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
150
All clinicians will attend an educational session where they will be provided a clinical decision framework for management of chronic conditions in hospitalized older adults, reviewing guiding principles for managing chronic disease in the hospital, and working through case-based hypothetical examples.
University of Pittsburgh
Pittsburgh, Pennsylvania, United States
RECRUITINGClinician - Change in Prescribing Self-Efficacy
For each clinician participant the investigators will ask their self-efficacy to individualize blood pressure and diabetes treatment decisions for hospitalized older adults. Measured through ten 7-point Likert scale questions measured \[Strongly Disagree - Strongly Agree\]. Scores will be summed and range from 10 (all Strongly Disagree) to 70 (all Strongly Agree).
Time frame: Baseline and three months post-intervention
Clinician - Change in Attitudes
The investigators will ask clinicians 8 questions about their attitudes towards individualizing antihypertensive and diabetes treatment decisions on a 7-point Likert scale. Individualizing antihypertensive and diabetes treatment decisions for hospitalized older adults is: Necessary - Unnecessary Beneficial - Harmful High-priority - Low-priority Worthless - Useful. Scores will be summed and range from 8 to 56.
Time frame: Baseline and three months post-intervention
Clinician - Discharge Prescribing
For each clinician participant, the investigators will review the electronic health record for all hospitalized patients aged 65 years and older who were discharged alive under the clinician participant's care in the 2 months before and 3 months after the intervention to identify all antihypertensive and diabetes medication changes made during hospitalization. The investigators will compare the proportion of patients discharged with cardiometabolic medication changes in the 2 months prior to the intervention to the 3 months after the intervention. The investigators will examine proportion of patients receiving medication intensifications and the proportion receiving any medication change.
Time frame: Pre-intervention and post-intervention (2 months before and 3 months after the intervention)
Patient - Change in Medication Discrepencies
The investigators will ask each enrolled patient how they are taking each of their cardiometabolic medications and compare their current reported medication use to the hospital discharge summary. The investigators will compare the proportion of patient participants reported a medication discrepancy (taking medication differently than hospital discharge summary) in the pre-intervention period to the post-intervention period.
Time frame: Single time survey within a week of discharge from clinician participants care.
Clinician - Acceptability of Clinical Decision Framework
The investigators will ask clinicians if they used the clinical decision framework and 7 questions on a 7 point Likert scale (strongly disagree to strongly agree) regarding the framework's clarity, length, and whether it was useful. The investigators will ask what they liked about the framework and what would they change. The investigators will ask about facilitators and barriers to using the framework and whether they plan to keep using it. Scores will be summed and range from 7 to 49.
Time frame: 3 months post-intervention
Clinician - Change in Intentions
The investigators will ask each enrolled clinician two questions to assess choice predisposition (leaning) towards individualizing blood pressure and diabetes medications prescribing decisions during hospitalization using two 7-point Likert Scales (Strongly Disagree to Strongly Agree). Scores will be summed and range from 2 (all Strongly Disagree) to 14 (all Strongly Agree).
Time frame: Baseline and three months post-intervention
Clinician - Change in Perceived Norms
The investigators will ask each enrolled clinician six questions on their perceptions on norms on individualizing blood pressure and diabetes treatment decisions for hospitalized older adults. Measured through 7-point Likert scale questions measured \[Strongly Disagree - Strongly Agree\]. Scores will be summed and range from 6 (all Strongly Disagree) to 42 (all Strongly Agree).
Time frame: Baseline and three months post-intervention
Clinician - Awareness of Evidence Base
The investigators will ask each enrolled clinician to respond to four questions regarding their familiarity with the evidence base for the treatment of blood pressure and diabetes while a patient is hospitalized. These will be framed as four 7-point Likert Scales (Strongly Disagree to Strongly Agree). Scores will be summed and range from 4 (all Strongly Disagree) to 28 (all Strongly Agree).
Time frame: Baseline and three months post-intervention
Patient - Change in Overall Hospital Experience
The investigators will ask each enrolled patient to rate their overall hospital experience from 0 to 10. Where 0 is I had a very poor experience and 10 is I had a very good experience. Scores will be summed from 0 to 10. The investigators will compare average scores of patients in the pre-intervention period to the post-intervention period
Time frame: Baseline and three months post-intervention
Patient - Change in Experience in the Hospital
The investigators will ask each enrolled patient a 4 question survey on communication during their hospital stay. Possible answers include never (1), sometimes (2), usually (3), and always (4). Scores will be summed from 4 to 16. The investigators will compare mean scores of patients in the pre-intervention period to the post-intervention period.
Time frame: Baseline and three months post-intervention
Patient - Change in Experience Leaving the Hospital
The investigators will ask each enrolled patient a 3 question survey on communication when they left the hospital. Possible answers include not at all (1), partly (2), quite a bit (3), completely (4), and not applicable (0). Scores will be summed from 0 to 12. The investigators will compare mean scores of patients in the pre-intervention period to the post-intervention period.
Time frame: Baseline and three months post-intervention
Patient - Change in Understanding of Medication Changes
The investigators will ask each enrolled patient their understanding of the reason for each cardiometabolic medication change made at hospital discharge and compare their understanding to the hospital discharge summary rationale to identify concordant versus discordant understanding. The investigators will compare the proportion of patients with discordant understanding of cardiometabolic medication changes in the pre-intervention period to the post-intervention period.
Time frame: Baseline and three months post-intervention
Patient - Change in Comprehension of Disease Monitoring
The investigators will ask each patient participant enrolled if the hospital discussed their blood pressure and/or provided guidance on disease monitoring (e.g. blood pressure or blood glucose) after discharge. The investigators will compare the proportion of patients reporting guidance on disease monitoring from the pre-intervention to post-intervention period.
Time frame: Baseline and three months post-intervention
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