Measurement to improve care and outcomes for persons with Alzheimer’s Disease and dementia
October 3, 2022 Continue reading
Outcomes
The Patient-Centered Outcomes Research Institute (PCORI)
PCORI is a leader in driving US clinical research to becomes more patient-centered. They are committed to ensuring that patients and other healthcare stakeholders are involved throughout the research process, offering awards to promote engagement in research, dissemination and implementation projects, methodology research, and the development of research infrastructure.
CASI (Center for Aging and Serious Illness CASI) | Improving outcomes in aging and serious illness
The Center for Aging and Serious Illness (CASI) at Massachusetts General Hospital aims to improve the well-being of older adults and enhance the lived experience of those with advanced illnesses. By creating a pipeline of strong investigators, conducting applied clinical studies, and supporting a robust research community, CASI aims to engage aging populations in research, illuminate how to provide effective care for serious illnesses, and augment well-being for older adults and their care partners.
NIH Pragmatic Trials Collaboratory and Living Textbook
The NIH Pragmatic Trials Collaboratory aims to improve the way clinical trials are conducted by creating a new infrastructure for collaborative research with healthcare systems, ultimately ensuring that healthcare providers and patients can make decisions based on the best available clinical evidence. The Collaboratory supports the design and rapid execution of pragmatic clinical trial Demonstration Projects to address questions of major public health importance and engage healthcare delivery systems in research partnerships. The Collaboratory also provides training resources on how to design, conduct, and disseminate embedded pragmatic clinical trials (ePCTs).
Results from TRAIN-AD study published in JAMA Internal Medicine
A study team led by IMPACT’s Multiple Principal Investigator Susan Mitchell, PhD, MPH recently published results of a Trial to Reduce Antimicrobial Use in Nursing Home Residents with Alzheimer’s Disease and Other Dementias (TRAIN-AD). The journal article and an accompanying editorial were published in JAMA Internal Medicine on July 12th.
Mitchell and colleagues conducted a cluster randomized clinical trial of a multicomponent intervention designed to improve management of suspected urinary tract infections (UTIs) and lower respiratory infections (LRIs) for nursing home residents with advanced dementia. The trial was conducted at 28 Boston-area nursing homes (14 per arm). The intervention, which targeted nursing home care providers, integrated best practices from infection diseases and palliative care for management of suspected UTIs and LRIs in residents with advanced dementia. Researchers observed a clinically significant 33% reduction in antimicrobial courses for suspected lower respiratory infections (LRIs) and urinary tract infections (UTIs) among participants living in facilities assigned to the intervention. Although this result was underpowered to show a statistically significant reduction, the TRAIN-AD study was unique in that it completed a rigorous evaluation of an intervention to reduce antibiotics in people with advanced dementia.
The study team found that despite a comprehensive training approach that included an in-person seminar, online course, management algorithms, communication tips, and feedback reports and a high adherence to the training, the intervention did not significantly reduce antimicrobial use among nursing home residents with advanced dementia. However, both Mitchell’s team and the commentary authors noted the potential of the intervention to yield more significant results when scaled up and applied to a broader range of nursing home settings.
The study results were accompanied by an invited commentary from Shiwei Zhou, MD and Pretti N. Malani, MD, noting these strengths and describing the study as a “a low-cost, low risk, scalable intervention that is associated with a reduction in inappropriate antibiotic prescriptions is worthy of replication” from a stewardship perspective.
Read the full article here and commentary here.
Citation: Mitchell SL, D’Agata EMC, Hanson LC, et al. The trial to reduce antimicrobial use in nursing home residents with Alzheimer disease and other dementias (TRAIN-AD): a cluster randomized clinical trial. JAMA Intern Med. Published online July 12, 2021. doi:10.1001/jamainternmed.2021.3098
AcademyHealth report identifies health systems’ priority research questions on COVID-19
AcademyHealth has developed a report focused on information needs of the health care and community organizations engaged in the COVID-19 response. The report is intended to inform decision-making of federal and foundation funders of health services research to guide investments in responsive research.
Read the full report and background information on the AcademyHealth website.