IMPACT: Pathway to Detection & Differentiation of Delirium & Dementia in the Emergency Department

Sponsor

Yale University (Other)

Overall Status

Completed

CT.gov ID

NCT04846322

Collaborator

National Institute on Aging (NIA) (NIH)

100

Enrollment

Locations

Arm

14.5

Actual Duration (Months)

Patients Per Site

3.5

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

This is an observational study of the pragmatic implementation of an ED screening, outpatient referral, and care coordination process for older ED patients who may have UCID.

Condition or Disease	Intervention/Treatment	Phase
Cognitive Impairment Emergency Care Dementia Delirium	Diagnostic Test: PD4ED 3-step intervention (ED assessment, outpatient assessment, Brain health plan)	N/A

Detailed Description

Embedded pragmatic, implementation pilot that incorporates training, ED assessment for delirium and dementia risk, referral of ED patients with undiagnosed cognitive impairment and dementia for primary care feedback and care recommendations. This pilot would gather observational data evaluating the feasibility of incorporating cognitive impairment screens into routine ED delirium assessments, and developing optimal work flow for identifying and referring ED patients with suspected (undiagnosed) dementia for confirmatory evaluation and care coordination.

Study Design

Study Type:

Interventional

Actual Enrollment :

100 participants

Allocation:

N/A

Intervention Model:

Sequential Assignment

Masking:

None (Open Label)

Primary Purpose:

Screening

Official Title:

Pathway to Detection & Differentiation of Delirium & Dementia in the Emergency Department

Actual Study Start Date :

Apr 1, 2021

Actual Primary Completion Date :

Jun 15, 2022

Actual Study Completion Date :

Jun 15, 2022

Arms and Interventions

Arm	Intervention/Treatment
Other: ED delirium & dementia screening & outpatient referral Routine ED screening for delirium and memory problems with referral for outpatient assessment of cognitive impairment.	Diagnostic Test: PD4ED 3-step intervention (ED assessment, outpatient assessment, Brain health plan) ED assessment for suspected dementia. positive ED patients referred for outpatient clinic cognitive impairment assessment. positive clinic patients referred to primary care with brain health patient plan.

Arm

Intervention/Treatment

Other: ED delirium & dementia screening & outpatient referral

Routine ED screening for delirium and memory problems with referral for outpatient assessment of cognitive impairment.

Diagnostic Test: PD4ED 3-step intervention (ED assessment, outpatient assessment, Brain health plan)

ED assessment for suspected dementia. positive ED patients referred for outpatient clinic cognitive impairment assessment. positive clinic patients referred to primary care with brain health patient plan.

Outcome Measures

Primary Outcome Measures

ED screening rates of delirium vs. suspected dementia [30 days]
Number of patients 75+ screened / total number of ED visit by patients 75+
Detection rates of delirium vs. suspected dementia [30 days]
daily number of patients discharged from ED with positive suspected dementia screen / number of patients 75+ screened.
Rates of outpatient assessment referral of patients with suspected dementia [30 days]
number of patients with appointment to ADC or geriatrics outpatient clinic / number of patients given information sheet or referred to outpatient clinic
Rates of confirmed dementia or mild cognitive impairment [30 days]
number of patients positive for dementia or MCI / number of patients from ED seen at clinic with completion of UDS assessment
Rates of connection with primary care [30 days]
number of patients with PCP follow-up about brain health plan / number of patients with outpatient confirmation of Dementia or MCI

Eligibility Criteria

Criteria

Ages Eligible for Study:

65 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Adults age 65 or older
Discharged from the adult ED at YNHH or the ED at NMH

Exclusion Criteria:

Documented or known history of dementia
Alcohol/substance intoxication while in the ED
Non-English or Non-Spanish speaking

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Yale New Haven Hospital	New Haven	Connecticut	United States	06512
2	Northwestern	Chicago	Illinois	United States	60611

Sponsors and Collaborators

Yale University
National Institute on Aging (NIA)

Investigators

Principal Investigator: Ula Hwang, MD, Yale University

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

Responsible Party:

Yale University

ClinicalTrials.gov Identifier:

NCT04846322

Other Study ID Numbers:

2000029490
U54AG063546

First Posted:

Apr 15, 2021

Last Update Posted:

Aug 9, 2022

Last Verified:

Aug 1, 2022

Studies a U.S. FDA-regulated Drug Product:

Studies a U.S. FDA-regulated Device Product:

Keywords provided by Yale University

delirium

Additional relevant MeSH terms:

Dementia

Delirium

Emergencies

Study Results

No Results Posted as of Aug 9, 2022