Research

Our group conducts patient-oriented research within the Clinical Epidemiology and Research Center at the Veterans Affairs Health Care System in West Haven, Connecticut. We aim to recruit older adults with multiple chronic conditions. Below are the two areas for our clinical research:

One in three Americans 65 and older take five or more medications. As the number of medications increase, so does the risk of having a prescribing problem (i.e. drug interaction, side effect). One in two of older adults take a medication that is considered a potentially inappropriate medication.

Our group consists of an interdisciplinary team which includes expertise in biomedical informatics, web and systems design, geriatric medicine, and geriatric pharmacy. The aim of our work is to decrease potentially inappropriate medications and to identify medication regimens that may to too complex for the patients to manage. To do this, we created the Tool to Reduce Inappropriate Medications (TRIM). It consists of two web-based programs.

Data Extraction Program
This program extracts age, chronic conditions and medications from the electronic health record (EHR) in order to identify high-risk patients and provide data inputs for the second application.

Medication Evaluation Program
The second application is a medication evaluation program consisting of three components.

1. Web interface for chart review and telephone assessment of health and psychosocial status variables
2. Clinical algorithms providing an automated systematic evaluation of appropriateness using inputs from the EHR-extracted data and health and psychosocial status variables
3. Patient-specific medication management feedback report which is generated for the clinician

Document Links

TRIM Clinical Algorithms

Example Clinician Feedback Report

Niehoff KM, Rajeevan N, Charpentier P, Miler PL, Goldstein MK, Fried TR. Development of the Tool to Reduce Inappropriate Medications (TRIM): A Clinical Decision Support System to Improve Medication Prescribing for Older Adults. Pharmacotherapy, 2016. PMID: 27041466

Fried TR, Niehoff KM, Tija J, Redeker N, Goldstein MK. A Delphi process to address medication appropriateness for older persons with multiple chronic conditions. BMC Geriatr. 2016;6(1):67. PMID: 26979576

Advance care planning (ACP) is the process by which patients can prepare for how medical decisions will be made in the future at a time of decisional incapacity. Surrogates’ knowledge of patients’ preferences and goals of care can decrease the stress of surrogate decision-making; however, a systematic review concluded that surrogates are frequently unaware of these preferences.

The purpose of this study was to understand participation in ACP as a dyadic process for both patients and their potential surrogate decision makers.
Veterans and their surrogates each completed a closed-ended interview assessing their participation in four ACP activities:

1. Communication with loved one regarding the use of life-sustaining treatment
2. Communication with loved one regarding valuation of quantity versus quality of life
3. Formal appointment of a health care surrogate decision maker
4. Completion of a living will

Interview with the NEJM and Dr. Fried

Fried TR, Redding CA, Robbins ML, Paiva Al, O’Leary JR, Iannone L. Development of Personalized Health Messages to Promote Engagement in Advance Care Planning. J Am Geriatr Soc.2016; 64(2): 359-364. PMID: 26804791

Fried TR. Shared Decision Making--Finding the Sweet Spot. N Engl J Med. 2016;374(2): 104-106. PMID: 26760081