Increasing Recruitment of Hospitalized Older Adults for the Hospitalist Project: A Randomized Trial

Investigator: J’Heannhehbelle Rosier, BS
Advisor: David Meltzer, MD, PhD
Supported by funding from the National Institute on Aging

Since 1997, the Hospital Project has sought to survey all UCM general medicine and hospitalist inpatients (around 10k per year) with broad goals to improve care quality and outcomes, and to provide descriptive data on inpatients. The project has run into recruitment issues, with COVID decreasing consent rates below 70% and older patients proving more difficult to recruit and obtain consent from. The 75+ Consent project team aimed to: (1) develop and implement an intervention to increase recruitment of hospitalized older adults for the Hospitalist Project and address barriers to implementation, (2) assess how the intervention affects recruitment rates, and (3) understand how the effectiveness of the intervention varies by the quality of implementation.

The specialized team, comprised of a lead Clinical Research Coordinator (CRC) and 6 RAs focused on older patients aged 75 and up, reviewing charts, revisiting rooms daily until the outcome was reached, and identifying and addressing barriers such as outreach to proxies. The results were then compared against the patients assigned to the standardized control team, over three 1.5-month pulses.

The project found that:

• Overall, we are more likely to ‘lose’ patients who have short length of stays
• On weekends, there are more family visits, making it more difficult to get patients to complete an interview
• There is a long period between the time of talking to the proxy and actually meeting with them
• Many refusals occur because the patient or their proxy is concerned about their medical records being accessed
• 75+ patient interviews take significantly longer than normal hospitalist interviews. Typical survey duration for younger-middle aged patients in the Hospitalist Project is around 20 minutes, while 75+ patients often take 45-60 minutes
• 75+ patients are much more likely to be found sleeping throughout the day than general Hospitalist Project patients
• It is more likely to encounter patients who have varying impairments (hearing, visual, struggling to write)
• 75+ patients seem to be better at responding to more subjective than objective questions, or unstructured than structured questions. It was thus difficult to get fully accurate responses with anemia interviews which use numbers for rating fatigue levels

Based on the results shown in the study, the Hospitalist Project will seek to incorporate a team focused on older adults into their regular operations.