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READI-SET-GO: Researching Efficient Approaches to Delirium Identification - Sustaining Effective Translation to create Gero-friendly Organizations

Award Number: R01AG030618
ORGANIZATION: NATIONAL INSTITUTE ON AGING
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/01/2008
PERIOD OF PERFORMANCE END DATE: 05/31/2028

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READI-SET-GO: Researching Efficient Approaches to Delirium Identification - Sustaining Effective Translation to create Gero-friendly Organizations - ABSTRACT for READI-SET-GO Delirium has a devastating impact on older adults and their care partners. It is associated with in hospital adverse events (e.g., falls), declines in physical and cognitive function, nursing home placement and increased mortality. Despite its poor outcomes and high costs, < 50% of all delirium cases are detected in routine care. To address this challenge, in READI (Researching Efficient Approaches to Delirium Identification) we developed, validated, and field tested the Ultra-brief CAM (UB-CAM), a two-step delirium identification protocol that combines an ultra-brief 2-item screen (UB-2) with a validated diagnostic tool (3D-CAM). We enrolled 527 patients, avg. age 80 years, 35% with ADRD, at 2 study hospitals, performed reference standard delirium evaluations on 924 hospital days (153 with delirium), followed by blinded UB-CAM App-directed assessments by physicians, registered nurses, and certified nursing assistants. The UB-CAM was feasible (97% completion rate), brief (average 1 min 15 seconds), had overall accuracy of 89%, and performed well by all disciplines. We found similar positive results in the enriched subset of READI participants with Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (AD/ADRD). We simultaneously conducted qualitative research to understand barriers and facilitators to implementation of delirium screening. While READI substantially advanced the field, it did not test full scale implementation of screening among all hospitalized older adults. We now propose to take this critical next step in READI-SET-GO (READI—Sustaining Effective Translation to create Gero-Friendly Organizations) by integrating daily delirium screening using the UB-CAM into routine care for every older adult admitted to 6 acute medical/surgical units at 3 hospitals in 2 states. We will conduct a stepped-wedge implementation design, where UB-CAM screening will be launched at a new unit every 6 months over a 42-month study. We will utilize evidence-based implementation strategies and test fidelity, accuracy, sustainability, and impact. Using a pragmatic cohort of 20,000 older adults, plus a nested patient- oriented sample of 1050 older adults enriched for AD/ADRD, we propose the following Specific Aims, 1. To test the fidelity, accuracy, and sustainability of integrating daily nurse screening for delirium using the UB-CAM into routine care for all hospitalized older adults. 2. To evaluate the impact of UB-CAM delirium screening on patient and care partner centered outcomes and perceptions of care assessed at one month follow-up interviews. 3. To evaluate the impact of UB-CAM screening on rates of delirium complications (falls, pressure injury, aspiration) and adverse delirium management (psychoactive medication, restraint use). Findings from the proposed study will be readily adopted into clinical care and will directly inform best practices for delirium screening, particularly for vulnerable older individuals with AD/ADRD. Our results have the potential to make the hospital a safer place for older adults, improving outcomes and reducing distress.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $730,531 )
2025	2025	THE PENNSYLVANIA STATE UNIVERSITY	201 OLD MAIN	UNIVERSITY PARK	PA	16802	CENTRE	USA	Aging Research	000	11	7/15/2025	NON-COMPETING CONTINUATION	$730,531
														Subtotal = $730,531

Issue Date FY: 2024 ( Subtotal = $777,797 )
2024	2024	THE PENNSYLVANIA STATE UNIVERSITY	201 OLD MAIN	UNIVERSITY PARK	PA	16802	CENTRE	USA	Aging Research	001	10	6/5/2024	NON-COMPETING CONTINUATION	$777,797
2024	2023	THE PENNSYLVANIA STATE UNIVERSITY	201 OLD MAIN	UNIVERSITY PARK	PA	16802	CENTRE	USA	Aging Research	000	9	11/16/2023	COMPETING CONTINUATION	$0
2024	2019	BETH ISRAEL DEACONESS MEDICAL CENTER, INC.	330 BROOKLINE AVE	BOSTON	MA	02215	SUFFOLK	USA	Aging Research	002	8	9/23/2024	NON-COMPETING CONTINUATION	$0
														Subtotal = $777,797

Issue Date FY: 2023 ( Subtotal = $850,014 )
2023	2023	PENNSYLVANIA STATE UNIVERSITY, THE	201 OLD MAIN	UNIVERSITY PARK	PA	16802	CENTRE	USA	Aging Research	000	9	5/31/2023	COMPETING CONTINUATION	$850,014
														Subtotal = $850,014

Issue Date FY: 2022 ( Subtotal = $0 )
2022	2019	BETH ISRAEL DEACONESS MEDICAL CENTER, INC	330 BROOKLINE AVE	BOSTON	MA	02215	SUFFOLK	USA	Aging Research	000	8	5/12/2022	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2021 ( Subtotal = $0 )
2021	2019	BETH ISRAEL DEACONESS MEDICAL CENTER, INC	330 BROOKLINE AVE	BOSTON	MA	02215	SUFFOLK	USA	Aging Research	000	8	4/26/2021	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2019 ( Subtotal = $364,280 )
2019	2019	BETH ISRAEL DEACONESS MEDICAL CENTER, INC	330 BROOKLINE AVE	BOSTON	MA	02215	SUFFOLK	USA	Aging Research	000	8	3/26/2019	NON-COMPETING CONTINUATION	$364,280
														Subtotal = $364,280

Issue Date FY: 2018 ( Subtotal = $650,237 )
2018	2018	BETH ISRAEL DEACONESS MEDICAL CENTER, INC	330 BROOKLINE AVE	BOSTON	MA	02215	SUFFOLK	USA	Aging Research	000	7	4/17/2018	NON-COMPETING CONTINUATION	$650,237
														Subtotal = $650,237

Issue Date FY: 2017 ( Subtotal = $837,290 )
2017	2017	BETH ISRAEL DEACONESS MEDICAL CENTER, INC	330 BROOKLINE AVE	BOSTON	MA	02215	SUFFOLK	USA	Aging Research	000	6	3/23/2017	NON-COMPETING CONTINUATION	$605,796
2017	2017	BETH ISRAEL DEACONESS MEDICAL CENTER, INC	330 BROOKLINE AVE	BOSTON	MA	02215	SUFFOLK	USA	Aging Research	001	6	6/14/2017	NON-COMPETING CONTINUATION	$67,312
2017	2017	BETH ISRAEL DEACONESS MEDICAL CENTER, INC	330 BROOKLINE AVE	BOSTON	MA	02215	SUFFOLK	USA	Aging Research	002	6	8/28/2017	SUPPLEMENT FOR EXPANSION	$164,182
														Subtotal = $837,290

Issue Date FY: 2016 ( Subtotal = $692,752 )
2016	2016	BETH ISRAEL HOSPITAL	330 BROOKLINE AVENUE	BOSTON	MA	02215	SUFFOLK	USA	Aging Research	000	5	4/11/2016	COMPETING CONTINUATION	$692,752
														Subtotal = $692,752

Issue Date FY: 2014 ( Subtotal = $0 )
2014	2011	BETH ISRAEL HOSPITAL	330 BROOKLINE AVENUE	BOSTON	MA	02115	SUFFOLK	USA	Aging Research	000	4	6/16/2014	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2013 ( Subtotal = $0 )
2013	2011	BETH ISRAEL HOSPITAL	330 BROOKLINE AVENUE	BOSTON	MA	02115	SUFFOLK	USA	Aging Research	000	4	4/18/2013	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2011 ( Subtotal = $504,798 )
2011	2011	BETH ISRAEL HOSPITAL	330 BROOKLINE AVENUE	BOSTON	MA	02215	SUFFOLK	USA	Aging Research	000	4	6/29/2011	NON-COMPETING CONTINUATION	$504,798
														Subtotal = $504,798

Issue Date FY: 2010 ( Subtotal = $594,564 )
2010	2010	BETH ISRAEL HOSPITAL	330 BROOKLINE AVENUE	BOSTON	MA	02215	SUFFOLK	USA	Aging Research	000	3	6/21/2010	NON-COMPETING CONTINUATION	$594,564
														Subtotal = $594,564

Issue Date FY: 2009 ( Subtotal = $552,618 )
2009	2009	BETH ISRAEL HOSPITAL	330 BROOKLINE AVENUE	BOSTON	MA	02215	SUFFOLK	USA	Aging Research	000	2	6/22/2009	NON-COMPETING CONTINUATION	$552,618
														Subtotal = $552,618

Issue Date FY: 2008 ( Subtotal = $411,487 )
2008	2008	BETH ISRAEL HOSPITAL	330 BROOKLINE AVENUE	BOSTON	MA	02115	SUFFOLK	USA	Aging Research	000	1	8/29/2008	NEW	$411,487
														Subtotal = $411,487

Grand Total All Awards = $6,966,368

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READI-SET-GO: Researching Efficient Approaches to Delirium Identification - Sustaining Effective Translation to create Gero-friendly Organizations

Award Number: R01AG030618

ORGANIZATION: NATIONAL INSTITUTE ON AGING

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/01/2008

PERIOD OF PERFORMANCE END DATE: 05/31/2028

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