The goal of this observational study is to learn about automated referrals to Perioperative Optimization of Senior Health (POSH). The main question it aims to answer is: * Do automated referrals to POSH increase the number of people who attend the clinic?
Preoperative comprehensive geriatric assessment (pCGA) is an existing clinical intervention (herein referred to by the clinic that delivers the intervention, as Perioperative Optimization for Senior Health, POSH) to address frailty among older adults before elective surgery; however, this highly effective intervention is resource-intensive and variably delivered to a limited number of eligible patients. The researchers propose a 12-month trial embedded in the electronic health record that will test the effect of automated referrals to the POSH clinic on implementation outcomes (reach and adoption) of POSH and secondarily on the delivery of age-friendly process measures for surgical care (effectiveness). We hypothesize that randomizing frail older adults (age 80 years and older) who are planning major surgery to an automated referral will increase the reach of POSH, and the adoption among surgeons while simultaneously improving processes associated with age-friendly care (decreasing potentially inappropriate medication use as measured by anticholinergic burden (ACB) score, increasing documentation of baseline cognitive status, increasing use of physical therapy (PT) referrals, and improving the percentage of patients with advanced care planning paperwork on file before surgery).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
90
Participants who screen for frailty (using the frailty score calculator device embedded in the EHR) will receive an automated referral to POSH clinic through their electronic health record.
Surgeons will be notified of frailty score (as calculated using the frailty score calculator device embedded in the EHR). Surgeons can choose to refer patients directly to POSH.
University of Wisconsin
Madison, Wisconsin, United States
Number of participants who attend POSH
The number of eligible participants who attend POSH will be compared across arms.
Time frame: 90 days
Number of surgeons who refer to POSH
The number of surgeons who refer patients to POSH will be compared to those in the same clinical departments for both arms.
Time frame: 90 days
Anticholinergic Burden Score
Anticholinergic Burden (ACB) score measures the degree to which the patient's prescribed medications block the neurotransmitter acetylcholine. Median scores will be compared for the intervention and control groups. Higher scores in older adults correlate with increased risks of confusion, functional impairment, falls, and mortality.
Time frame: 90 days
Documentation of preoperative cognitive status
Number of eligible participants will be compared with number who have documented cognitive status according to a validated cognitive screening instrument.
Time frame: 90 days
Physical therapy (PT) referrals
The number of eligible participants compared to participants who receive a PT referral.
Time frame: 90 days
Advanced care planning (ACP) on file
Number of participants with ACP on file before surgery will be compared to number of eligible participants.
Time frame: 90 days
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