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Multicenter Study
. 2024 Dec 2;24(1):986.
doi: 10.1186/s12877-024-05548-3.

The impact of the Dementia Care in Hospitals Program on hospital acquired complications - a non-randomised stepped wedge hybrid effectiveness-implementation study

Mark W Yates  1 , Kasia Bail  2 , Sean MacDermott  3 , David Skvarc  4 , Meredith Theobald  5 , Michelle Morvell  5 , Jessica C Jebramek  4 , Ian Tebbut  6 , Brian Draper  7 , Henry Brodaty  8
Affiliations
Multicenter Study

The impact of the Dementia Care in Hospitals Program on hospital acquired complications - a non-randomised stepped wedge hybrid effectiveness-implementation study

Mark W Yates et al. BMC Geriatr. .

Abstract

Background: Hospitalized older patients with cognitive impairment (CI) experience poor outcomes and high rates of hospital acquired complications (HACs). This study investigated the effectiveness of a multimodal hospital CI identification and education program.

Method: A prospective stepped-wedge, cross-sectional, continuous-recruitment, hybrid effectiveness-Implementation study was conducted in acute hospitals in four Australian states/territories. The intervention, the Dementia Care in Hospitals Program (DHCP) provided: clinical/ non-clinical hospital staff CI awareness support and education; CI screening for older patients and a bedside alert-the Cognitive Impairment Identifier (CII). The primary outcome was change in the rate of the combined risk of four HACs (urinary tract infection, pneumonia, new onset delirium, pressure injury).

Results: Participants were patients aged 65 years and over admitted for 24 h or more over a 12-month period between 2015-2017 (n = 16,789). Of the 11,309 (67.4%) screened, 4,277 (37.8%) had CI. HACs occurred in 27.4% of all screened patients and were three times more likely in patients with CI after controlling for age and sex (RR = 3.03; 95%CI:2.74-3.27). There was no significant change in HAC rate for patients with CI (RR = 1.084; 95%CI: 0.93; 1.26). In the intervention period the raw HAC rate for all screened patients was 27.0%, which when adjusted for age and sex suggested a small reduction overall. However, when adjusted for hospital site, this reduction in HAC risk not statistically significant (RR = 0.968; 95%CI:0.865-1.083). There was considerable interhospital variation in intervention implementation and outcomes which explains the final non-significant effect.

Conclusion: For patient with CI the implementation of the DCHP did not result in a reduction in HAC rates. Education for hospital staff regarding cognitive impairment screening, care support, carer engagement and bedside alerts, using the DCHP, can be feasibly implemented in acute hospitals. Reducing high frequency HACs in older hospital patients with CI, warrants further research.

Trial registration: The trial was registered retrospectively with the Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12615000905561 on 01/09/2015 with 92 patients (0.8% of total sample) recruited in the baseline and none in the intervention before registration submission.

Keywords: Adverse events; Cognitive impairment; Delirium; Effectiveness; Hospitals; Multi-modal interventions; Trial.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study protocol, including a waiver of consent, was approved by the relevant Ethics Committee at each site: HREC/15/TQEH/9 (Government of South Australia, SA Health, Human Research Ethics Committee); ETH.6.15.105 (ACT Health, Human Research Ethics Committee); HREC/15/TQEH/9 (Human Research Ethics Committee (Tasmania) Network); 2015–103 (Government of Western Australia, Department of Health, Human Research Ethics Committee). This study was performed in accordance with the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The CII is copyright to Grampians Health to protect its integrity; MY, MT, MM are employees of Grampians Health and could be perceived to have a competing interest. None of the other authors have a conflict of interest. The CII was developed with government funding and is freely available to hospital services in Australia who agree to incorporate the key elements of the DCHP into their hospital care. ( https://www.bhs.org.au/services-and-clinics/dementia-care-in-hospitals-program/ ).

Figures

Fig.1
Fig.1
The CII and communication strategies
Fig. 2
Fig. 2
Study Population and Disposition. CI – Cognitive Impairment. HAC Positive – Experience one or more of the four target Hospital Acquired Complications. HAC Negative – Experiences none of the four target Hospital Acquired Complications * = p < 0.05
See this image and copyright information in PMC

References

    1. AIHW. Hospital care for people with dementia 2016–17. Canberra: Australian Institute of Health and Welfare; 2019.
    1. Australian Institute of Health and Welfare 2013. Dementia care in hospitals: costs and strategies. Cat. no. AGE 72. Canberra: AIHW.
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    1. Bail K, Goss J, Draper B, Berry H, Karmel R, Gibson D. The cost of hospital-acquired complications for older people with and without dementia; a retrospective cohort study. BMC Health Serv Res. 2015;15:91. - PMC - PubMed

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