Optimizing Prescribing Decisions for Hospitalized Older Adults With Chronic Conditions

For each clinician participant the investigators will ask their self-efficacy to individualize blood pressure and diabetes treatment decisions for hospitalized older adults. Measured through ten 7-point Likert scale questions measured [Strongly Disagree - Strongly Agree]. Scores will be summed and range from 10 (all Strongly Disagree) to 70 (all Strongly Agree).

The investigators will ask clinicians 8 questions about their attitudes towards individualizing antihypertensive and diabetes treatment decisions on a 7-point Likert scale. Individualizing antihypertensive and diabetes treatment decisions for hospitalized older adults is:

Necessary - Unnecessary Beneficial - Harmful High-priority - Low-priority Worthless - Useful.

Scores will be summed and range from 8 to 56.

For each clinician participant, the investigators will review the electronic health record for all hospitalized patients aged 65 years and older who were discharged alive under the clinician participant's care in the 2 months before and 3 months after the intervention to identify all antihypertensive and diabetes medication changes made during hospitalization. The investigators will compare the proportion of patients discharged with cardiometabolic medication changes in the 2 months prior to the intervention to the 3 months after the intervention. The investigators will examine proportion of patients receiving medication intensifications and the proportion receiving any medication change.

The investigators will ask each enrolled patient how they are taking each of their cardiometabolic medications and compare their current reported medication use to the hospital discharge summary. The investigators will compare the proportion of patient participants reported a medication discrepancy (taking medication differently than hospital discharge summary) in the pre-intervention period to the post-intervention period.

The investigators will ask clinicians if they used the clinical decision framework and 7 questions on a 7 point Likert scale (strongly disagree to strongly agree) regarding the framework's clarity, length, and whether it was useful. The investigators will ask what they liked about the framework and what would they change. The investigators will ask about facilitators and barriers to using the framework and whether they plan to keep using it. Scores will be summed and range from 7 to 49.

The investigators will ask each enrolled clinician two questions to assess choice predisposition (leaning) towards individualizing blood pressure and diabetes medications prescribing decisions during hospitalization using two 7-point Likert Scales (Strongly Disagree to Strongly Agree). Scores will be summed and range from 2 (all Strongly Disagree) to 14 (all Strongly Agree).

The investigators will ask each enrolled clinician six questions on their perceptions on norms on individualizing blood pressure and diabetes treatment decisions for hospitalized older adults. Measured through 7-point Likert scale questions measured [Strongly Disagree - Strongly Agree]. Scores will be summed and range from 6 (all Strongly Disagree) to 42 (all Strongly Agree).

The investigators will ask each enrolled clinician to respond to four questions regarding their familiarity with the evidence base for the treatment of blood pressure and diabetes while a patient is hospitalized. These will be framed as four 7-point Likert Scales (Strongly Disagree to Strongly Agree). Scores will be summed and range from 4 (all Strongly Disagree) to 28 (all Strongly Agree).

The investigators will ask each enrolled patient to rate their overall hospital experience from 0 to 10. Where 0 is I had a very poor experience and 10 is I had a very good experience. Scores will be summed from 0 to 10. The investigators will compare average scores of patients in the pre-intervention period to the post-intervention period

The investigators will ask each enrolled patient a 4 question survey on communication during their hospital stay. Possible answers include never (1), sometimes (2), usually (3), and always (4). Scores will be summed from 4 to 16. The investigators will compare mean scores of patients in the pre-intervention period to the post-intervention period.

The investigators will ask each enrolled patient a 3 question survey on communication when they left the hospital. Possible answers include not at all (1), partly (2), quite a bit (3), completely (4), and not applicable (0). Scores will be summed from 0 to 12. The investigators will compare mean scores of patients in the pre-intervention period to the post-intervention period.

The investigators will ask each enrolled patient their understanding of the reason for each cardiometabolic medication change made at hospital discharge and compare their understanding to the hospital discharge summary rationale to identify concordant versus discordant understanding. The investigators will compare the proportion of patients with discordant understanding of cardiometabolic medication changes in the pre-intervention period to the post-intervention period.

The investigators will ask each patient participant enrolled if the hospital discussed their blood pressure and/or provided guidance on disease monitoring (e.g. blood pressure or blood glucose) after discharge. The investigators will compare the proportion of patients reporting guidance on disease monitoring from the pre-intervention to post-intervention period.