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

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.

Study Overview

• Status: Completed
• Conditions: Delirium; Cognitive Impairment; Dementia; Emergency Care
• Intervention / Treatment: Diagnostic test: PD4ED 3-step intervention (ED assessment, outpatient assessment, Brain health plan)

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 Type: Observational
• Enrollment (Actual): 100
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Connecticut
    • New Haven, Connecticut, United States, 06512
      • Yale New Haven Hospital
  • Illinois
    • Chicago, Illinois, United States, 60611
      • Northwestern

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years and older (Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

All community dwelling ED patients 65 years of age or older seen in the Yale New Haven Health System (YNHHS) St. Raphael's Campus (SRC) ED or Northwestern Memorial Hospital (NMH) ED.

Description

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

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Patients With Confirmed Delirium or Dementia	percentage of patients discharged from ED positive for delirium or dementia among total number of patients 65+	1 year
Rates of Outpatient Assessment Referral of Patients With Suspected Dementia	number of patients with appointment to Alzheimer's Dementia Centers or geriatrics outpatient clinic / number of patients given information sheet or referred to outpatient clinic	30 days
Number of Participants Diagnosed With Dementia Among Those With Completed Outpatient Assessment	number of patients diagnosed with dementia (all categories) among those that completed the outpatient assessment	Up to 100 days from ED discharge
Rates of Connection With Primary Care	number of patients with PCP follow-up about brain health plan of the number of patients with outpatient confirmation of Dementia or MCI	30 days

Collaborators and Investigators

• Sponsor: Yale University
• Collaborators: National Institute on Aging (NIA)
• Investigators: Principal Investigator: Ula Hwang, MD, Yale University

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2021
• Primary Completion (Actual): August 15, 2022
• Study Completion (Actual): August 15, 2022

Study Registration Dates

• First Submitted: March 25, 2021
• First Submitted That Met QC Criteria: April 14, 2021
• First Posted (Actual): April 15, 2021

Study Record Updates

• Last Update Posted (Actual): March 7, 2024
• Last Update Submitted That Met QC Criteria: February 13, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Keywords: delirium
• Additional Relevant MeSH Terms: Mental Disorders; Pathologic Processes; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurologic Manifestations; Confusion; Neurobehavioral Manifestations; Neurocognitive Disorders; Disease Attributes; Delirium; Emergencies; Dementia
• Other Study ID Numbers: 2000029490; U54AG063546 (U.S. NIH Grant/Contract)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No