Ariba Khan1, Olga Boukrina2, Mooyeon Oh-Park3, Nina A Flanagan4, Maharaj Singh5, Mark Oldham6. 1. Department of Geriatrics, Advocate Aurora Health Care, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin. 2. Kessler Foundation, Center for Stroke Rehabilitation Research, West Orange, New Jersey. 3. Burke Rehabilitation Hospital, White Plains, New York. 4. Decker School of Nursing Binghamton University, Vestal, New York. 5. Aurora Research Institute, Aurora Health Care; Milwaukee, Wisconsin. 6. University of Rochester Medical Center, Department of Psychiatry, Rochester, New York.
Abstract
BACKGROUND: Each hospital day of delirium incurs greater healthcare costs, higher levels of care, greater staff burden, and higher complication rates. Accordingly, administrators are incentivized to identify models of care that reduce delirium rates and associated costs. PURPOSE: We present a systematic review and meta-analysis of delirium prevention models of care. DATA SOURCES: Ovid MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, EMBASE, and PsycINFO. STUDY SELECTION: Eligible models of care were defined as provider-oriented interventions involving revision of professional roles, multidisciplinary teams, and service integration. Included studies implemented multidomain, multicomponent interventions, used a validated delirium instrument, and enrolled a control group to evaluate efficacy or effectiveness. DATA EXTRACTION: We extracted data on study design, population, model of care, outcomes, and results. DATA SYNTHESIS: A total of 15 studies were included. All but two studies reported reduction in delirium or its duration, and 11 studies reported statistically significant improvements. Using random effects models, the pooled odds ratios of delirium incidence were 0.56 (95% CI: 0.37-0.85) from three randomized controlled trials, 0.63 (95% CI 0.37-1.07) from four pre-post intervention studies, and 0.79 (95% CI: 0.46-1.37) from three additional nonrandomized studies. CONCLUSIONS: Several models of care can prevent delirium. In general, higher quality studies were more likely to demonstrate statistical significance of an effect. The diverse models of care included here explored interventions adapted to specific care settings, especially by addressing setting-specific delirium risk factors. These care models illustrate a range of promising strategies that deserve growing recognition, refinement, and implementation.
BACKGROUND: Each hospital day of delirium incurs greater healthcare costs, higher levels of care, greater staff burden, and higher complication rates. Accordingly, administrators are incentivized to identify models of care that reduce delirium rates and associated costs. PURPOSE: We present a systematic review and meta-analysis of delirium prevention models of care. DATA SOURCES: Ovid MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, EMBASE, and PsycINFO. STUDY SELECTION: Eligible models of care were defined as provider-oriented interventions involving revision of professional roles, multidisciplinary teams, and service integration. Included studies implemented multidomain, multicomponent interventions, used a validated delirium instrument, and enrolled a control group to evaluate efficacy or effectiveness. DATA EXTRACTION: We extracted data on study design, population, model of care, outcomes, and results. DATA SYNTHESIS: A total of 15 studies were included. All but two studies reported reduction in delirium or its duration, and 11 studies reported statistically significant improvements. Using random effects models, the pooled odds ratios of delirium incidence were 0.56 (95% CI: 0.37-0.85) from three randomized controlled trials, 0.63 (95% CI 0.37-1.07) from four pre-post intervention studies, and 0.79 (95% CI: 0.46-1.37) from three additional nonrandomized studies. CONCLUSIONS: Several models of care can prevent delirium. In general, higher quality studies were more likely to demonstrate statistical significance of an effect. The diverse models of care included here explored interventions adapted to specific care settings, especially by addressing setting-specific delirium risk factors. These care models illustrate a range of promising strategies that deserve growing recognition, refinement, and implementation.
Authors: Sandeep R Pagali; Donna Miller; Karen Fischer; Darrell Schroeder; Norman Egger; Dennis M Manning; Maria I Lapid; Robert J Pignolo; M Caroline Burton Journal: Mayo Clin Proc Date: 2021-02-10 Impact factor: 7.616
Authors: Maya M Jeyaraman; Nameer Al-Yousif; Reid C Robson; Leslie Copstein; Chakrapani Balijepalli; Kimberly Hofer; Mir S Fazeli; Mohammed T Ansari; Andrea C Tricco; Rasheda Rabbani; Ahmed M Abou-Setta Journal: Syst Rev Date: 2020-02-12