• Ariba Khan, Olga Boukrina, Mooyeon Oh-Park, Nina A Flanagan, Maharaj Singh, and Mark Oldham.
• Department of Geriatrics, Advocate Aurora Health Care, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin.
• J Hosp Med. 2019 Sep 1; 14 (9): 558564558-564.

BackgroundEach 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.PurposeWe present a systematic review and meta-analysis of delirium prevention models of care.Data SourcesOvid MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, EMBASE, and PsycINFO.Study SelectionEligible 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 ExtractionWe extracted data on study design; Population, model of care, outcomes, and results.Data SynthesisA 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.ConclusionsSeveral 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.© 2019 Society of Hospital Medicine.

20 keywords...

hide…