Implementation & Innovation in Aging (I2A) Lab

We used an innovative cloud-based software system to develop real-time measurement of vital signs and create an automated alert system. Using our implementation science approach, we improved the rapid response team performance including earlier recognition of decompensation through a combination of the cloud-based alert system and redesign of the rapid response team processes. Among patients who were evaluated by this team, we observed a 47 percent reduction in hospital mortality from baseline and a 4.7 day reduction in hospital length of stay.  These system redesign efforts resulted in significant clinical improvements and potential cost savings.

The model was developed in outpatient clinics at the Houston VA and testing in a single-site randomized clinical trial (published in Archives Internal Medicine, Naik et al. 2011). The model uses peer-training and motivational theories of health behavior change. We then conducted an implementation science study to evaluate the uptake of this model in VA clinics across Chicago and Houston. We trained routine primary care teams to use this model as part of their routine care and conducted a multi-site randomized clinical trial of 280 patients. We found significant improvements in diabetes control (measured by hemoglobin A1c) and diabetes-related quality of life (measured by diabetes distress scale) after the intervention compared with control group. The team has developed on-line clinician training and a toolkit to facilitate implementation in future clinic sites. This innovative program can improve outcomes and reduce patient discomfort.

Physical frailty is common in adults with heart failure and increases the risk for poor health outcomes. Clinicians need tools to identify adults with physical frailty as part of routine care to support early intervention to treat frailty and reduce this risk. This project seeks to develop a novel measure of physical frailty using data collected as part of routine clinical care and recorded in the electronic health record.

Dr. Molly Horstman was recently awarded a Mentored Physician-Scientist Award in Alzheimer’s Disease and Related Dementias funded by VA Health Services Research and Development and the National Institute of Aging. Using a planned adaptation approach, Dr. Horstman and her research team will develop and test a new and unique intervention that combines evidence-based care transitions training with evidence-based dementia caregiver support. Dr. Horstman’s mentorship team for his award includes, Dr. Mark Kunik (Baylor College of Medicine; Center for Innovations in Quality, Effectiveness and Safety), Dr. Alan Stevens (Baylor Scott and White Health), and Dr. Aanand Naik (Baylor College of Medicine; Center for Innovations in Quality, Effectiveness and Safety).