Brain Health Patient Safety Learning Laboratory (Brain Safety Lab)

Principal Investigator: Christopher Callahan, M.D., Indiana University, Indianapolis, IN
AHRQ Grant No.: HS24384
Project Period: 09/30/15-03/31/20
Description: The overall goal of this learning laboratory was to prevent harms to brain health among vulnerable older adults. The Brain Safety Lab was a collaboration between Indiana University’s Schools of Medicine, Informatics and Computing, and Nursing; Purdue University's Schools of Biomedical and Industrial Engineering and its College of Pharmacy; the Regenstrief Institute; and Eskenazi Health, a safety-net healthcare system.

The project aims were to:

• Reduce the use of unsafe medications with anticholinergic (ACh) side effects.
• Prevent repeated episodes of hypoglycemia (HG) among older adults with diabetes.

The lab team comprised geriatric medicine clinicians, pharmacists, social scientists with expertise in behavioral economics, informaticians, human factors and systems engineers, biostatisticians, and implementation scientists. Using a five-phase process (i.e., problem analysis, design, development, implementation, and evaluation), the lab team:

• Developed and tested the usability and feasibility of Brain Buddy, a consumer-facing mHealth application to inform and encourage older adults to initiate dialogue with a clinician regarding the risks and benefits of their anticholinergic medications. (Note: The Brain Buddy app is not yet publicly available. A modified version of the app, "Brain Safe," is currently being evaluated in a separately funded clinical trial, NCT04121858.) All primary care patients who participated in the testing felt 100 percent more informed, with 94 percent indicating they would speak to their physician about their anticholinergic-related risk. On followup, 82 percent reported having spoken to their physician about their anticholinergic medication, a rate independently confirmed by physicians.^[1]
• Developed a conceptual model for over-the-counter medication purchase and use by older adults based on habits and deliberation. This model suggests several design directions for consumer-oriented interventions to promote medication safety.^[2]
• Innovated and tested the feasibility of using personalized music for ICU patients on a ventilator. Researchers estimated the effect of this nonpharmacologic intervention on delirium, finding that their study’s promising results warrant further research. Overall, patients enjoyed the music and were more likely to adhere to the ventilation.^[3]
• Validated the self-report version of the Healthy Aging Brain Care Monitor as a clinical tool for assessing symptoms of post-intensive care syndrome.^[4]
• Revised the 10-item Simplified System Usability Scale (SUS) for Cognitively Impaired and Older Adults, to improve ease of administration by practitioners for work with vulnerable populations.^[5]
• Found through a secondary data analysis that increased delirium severity and days of delirium or coma were associated with higher mortality risk 2 years after discharge.

To date, this PSLL's work has resulted in at least 18 peer-reviewed journal publications, with nearly 130 citations in other publications.

Publications

2021

• Holden RJ,. Abebe E, Medication transitions: vulnerable periods of change in need of human factors and ergonomics. Appl Ergon. 2021;90:103279.

2020

• Holden RJ, et al. Usability and feasibility of consumer-facing technology to reduce unsafe medication use by older adults. Res Social Adm Pharm. 2020;16(1):54-61.
• Khan SH, et al. Decreasing delirium through music: a randomized pilot trial. Am J Crit Care. 2020;29(2):e31-e38.
• Holden RJ.  A Simplified System Usability Scale (SUS) for cognitively impaired and older adults. Proc Int Symp Hum Factors Ergon Healthc. 2020;9(1):180-2.
• Andrews PS, et al. Relationship between intensive care unit delirium severity and 2-year mortality and health care utilization. Am J Crit Care. 2020;29(4):311-7.

2019

• Holden RJ, et al. Understanding older adults' medication decision making and behavior: a study on over-the-counter (OTC) anticholinergic medications. Res Social Adm Pharm. 2019;15(1):53-60.
• Campbell NL, Holden R, Boustani MA. Preventing Alzheimer disease by deprescribing anticholinergic medications. JAMA Intern Med. 2019 Jun 24. Online ahead of print.
• Wang S, et al. Validation of a new clinical tool for post-intensive care syndrome. Am J Crit Care. 2019;28(1):10-18.
• Hendrie K, et al. Longitudinal trends in incidence and prevalence of delirium in the intensive care unit. Am J Geriatr Psychiatry. 2019;27(3):S156-S157.
• Wang S, et al. Psychiatric symptoms and their association with sleep disturbances in intensive care unit survivors. Int J Gen Med. 2019;12:125-30.
• Hunter SR, et al. An introduction to multiobjective simulation optimization. ACM Trans Model Comput Simul 2019;29(1):Article 7.

2018

• Callahan CM, et al. State of science: bridging the science-practice gap in aging, dementia, and mental health. J Am Geriatr Soc. 2018;66 Suppl 1:S28-S35.
• Masud A, Tu W,  Yu Z. Variable selection for mixture and promotion time cure rate models. Stat Methods Med Res. 2018;27(7):2185-99.
• Li Z, Liu H, Tu W, Model selection in multivariate semiparametric regression. Stat Methods Med Res. 2018;27(10):3026-38.
• Khan S, et al. Mobile critical care recovery program (m-CCRP) for acute respiratory failure survivors: study protocol for a randomized controlled trial. Trials. 2018;19(1):94.

2017

• Wang S, et al. Antidepressant use and depressive symptoms in intensive care unit survivors. J Hosp Med. 2017;12(9):731-4.
• Chui MA, et al. Human factors in pharmacy. Proc Hum Factors Ergon Soc Annu Meet. 2017;61(1):666-70.

2016

• Clark DO, et al. Does body mass index modify memory, reasoning, and speed of processing training effects in older adults. Obesity (Silver Spring). 2016;24(11):2319-26.

References

1. Holden RJ, et al. Usability and feasibility of consumer-facing technology to reduce unsafe medication use by older adults. Res Social Adm Pharm. 2020;16(1):54-61.
2. Holden RJ, et al. Understanding older adults' medication decision making and behavior: a study on over-the-counter (OTC) anticholinergic medications. Res Social Adm Pharm. 2019;15(1):53-60.
3. Khan SH, et al. Decreasing delirium through music: a randomized pilot trial. Am J Crit Care. 2020;29(2):e31-e38.
4. Wang S. et al. Validation of a new clinical tool for post-intensive care syndrome. Am J Crit Care. 2019;28(1):10-18.
5. Holden RJ. A Simplified System Usability Scale (SUS) for cognitively impaired and older adults. Proc Int Symp Hum Factors Ergon Healthc. 2020;9(1):180-2.