Patient‐reported outcome measure use among older adults after emergency department care: A systematic review

Academic Emergency Medicine, Journal Year: 2024, Volume and Issue: 31(3), P. 273 - 287

Published: Feb. 17, 2024

Abstract Background Patient‐reported outcome measures (PROMs) are gaining favor in clinical and research settings given their ability to capture a patient's symptom burden, functional status, quality of life. Our objective this systematic review was summarize studies including PROMs assessed among older adults (age ≥ 65 years) after seeking emergency care. Methods With the assistance medical librarian, we searched Ovid MEDLINE, PubMed, Embase, CINAHL, Web Science‐Core Collection, Cochrane CENTRAL from inception through June 2023 for which adult ED patients had post–emergency care time period. Independent reviewers performed title/abstract review, full‐text screening, data extraction, study characteristic summarization, risk‐of‐bias (RoB) assessments. Results search strategy yielded 5153 56 met inclusion criteria. Within included studies, 304 unique PROM assessments were at varying points visit, 61 PROMs. The most commonly measured domain physical function, within majority (47/56; 84%), with such as Katz activities daily living (ADLs), instrumental ADLs, Barthel Index. frequently 1–3 months an visit (113/304; 37%), greater than 6 (91/304; 30%), 4–6 (88/304; 29%), very few 1 month (12/304; 4%). Of 16 interventional two determined have low RoB, four moderate nine high one insufficient information. 40 observational 10 be good quality, 20 poor quality. Conclusions following occurring first visit.

Language: Английский

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“Follow‐up in a few days”: Limitations to primary care access among older adults following emergency department discharge

Journal of the American Geriatrics Society, Journal Year: 2024, Volume and Issue: 72(5), P. 1528 - 1531

Published: Feb. 2, 2024

Older adults are at particular risk of clinical deterioration in the days after emergency department (ED) discharge as many face challenges implementing new or modified care plans.1, 2 Multidisciplinary expert consensus groups have recommended prioritizing efforts to further understand ED-to-community transitions for older patients.3, 4 navigating experience difficulty completing primary provider (PCP) follow-up,1, 5 with approximately 40% able obtain follow-up their PCP by day 7 and 70% 30.6 To address concerns remaining questions, a more rapid has been encouraged often-used ED mantra, "Follow-up your next 3-5 days," yet little data exist detailing outcomes within that acute post-ED time period.7, 8 Our objectives were describe proportion discharged from access 4-day evaluate patient's perceived success transition. We conducted secondary analysis observational prospectively collected part Geriatric Emergency Applied Research Standardization Study (GEARSS), multicenter cohort study enrolled seen geographically diverse EDs. Eligible patients English-speaking 65+ years age. Legally authorized representatives sought eligible participants impaired decision-making capacity. Individual institutional review boards approved protocol. The outcome was discharge, met if participant reported having any in-person, teleconference, medical office visits since index visit. Additionally, 12-item Care Transitions Score (CTS-12), designed (GEAR) Task Force, asked on Questions addressed participant's preparedness transition inquiring about they ED, preparation leave appointment plans (Table 1). identified days. calculated mean scores each individual 12 questions overall CTS-12 4. For small number 'missing' responses we then performed imputation.9 finally used t-test compare between those without follow-up. sample consisted 223 160 complete calculation Participants primarily female (64.6%), white (54.7%), exhibited age 73.3 years. Most (79.8%) under (Supplemental Table S1). Of discharged, 58 (26.0%) obtained significantly higher (36.8, 95% confidence interval [CI] 35.0–38.7) when compared did not (34.1, CI 32.7–35.5; p = 0.025) (Figure 1 & Supplemental S2). Given early vulnerability harm poor transitions, this work reflects an important extension prior research assessed care.6 In our population, one four Although common instructions recommendations suggest few days, appears be unobtainable majority ED. Leading organizations support practice care,10 no agreed upon period recommendation reached date. Future is needed identify optimal high-risk populations would particularly benefit also demonstrated feasibility environment its association absolute difference small, offers potential patient-reported measure could administered timeframe. limitations consider. unable assess patient attempted schedule but due scheduling difficulties. There possibility considered visiting nurse home health staff visit, thereby meeting outcome, potentially resulting slight overestimation traditional outpatient care. Finally, tool formally validated, performance metrics unknown. summary, completed had favorable perception transition, evidenced through novel application Score. concept design: Cameron J. Gettel. Acquisition data: Analysis interpretation Gettel, John Hartzheim, Tonya Chera, James Galske, Lauren M. Cameron-Comasco, Fernanda Bellolio, Lily Berrin, Arjun K. Venkatesh. Preparation manuscript: Hartzheim. authors like acknowledge who participated teams original GEARSS collection. All other declare conflicts interest relevant study. Dr. Gettel received National Institute Aging (NIA) Institutes Health (NIH; R03AG073988, R33AG058926), West Institute, American Board Medicine / Academy Fellowship, COVID-19 Fund Retain Clinical Scientists Yale, sponsored Doris Duke Charitable Foundation award #2021266, Yale Center Investigation. funders role design conduct study; collection, management, analysis, data; approval manuscript. sponsors S1. Sample characteristics. S2. Day 12-Item (CTS-12) Please note: publisher responsible content functionality supporting information supplied authors. Any queries (other than missing content) should directed corresponding author article.

Language: Английский

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Geriatric Emergency Departments: Emerging Themes and Directions

Current Geriatrics Reports, Journal Year: 2024, Volume and Issue: 13(2), P. 34 - 42

Published: March 4, 2024

Abstract Purpose of the Review Globally, emergency departments are recognizing their rapidly growing number older adult patients and some have responded with care models associated processes broadly described under umbrella geriatric (Geriatric EDs). This review seeks to identify emerging themes in Geriatric ED literature from period 2018–2023 provide a synthesis concepts research assist medicine healthcare professionals policymakers improving delivery medical patients. Recent Findings Emerging EDs include “calls action” field regarding 1) health system level integration; 2) developing processes; 3) implementing minimum standards; and, 4) setting future agendas. The is international scope contributions Canada, Australia, United Kingdom, Belgium, States among others. A focus on EDs’ financial sustainability as well overall efficacy model apparent. seminal resources Emergency Department Collaborative, Care Applied Research Network, Accreditation program. Attention workforce education specific process/protocols for screening/assessment, cognitive dysfunction falls growing. Overall findings support effectiveness potential enhancing adults. Summary providing an overview current directions through thematic analysis literature. Key four action”, assessment model’s sustainability, examination quality, identification key foundational EDs. Targeted programs attention contributing outcomes ED.

Language: Английский

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Are Specialty Emergency Departments the Future of Emergency Care? Oncology- and Geriatric-Focused Emergency Departments Hope to Improve Care, Lower Costs

Annals of Emergency Medicine, Journal Year: 2024, Volume and Issue: 83(5), P. A9 - A12

Published: April 18, 2024

Emergency physicians diagnose and manage all types of health emergencies. But specialty emergency departments (EDs) that focus on narrower groups patients with specific emergencies—oncologic, geriatric, orthopedic, other more select populations—are becoming common. Will the increased development specialized care sites move medicine away from its generalist roots?

Language: Английский

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Pragmatism and feasibility: A qualitative study of experiences implementing and upgrading care in geriatric emergency departments

Journal of the American College of Emergency Physicians Open, Journal Year: 2024, Volume and Issue: 5(4)

Published: June 26, 2024

Abstract Objectives Implementation and sustainability of new care processes in emergency departments (EDs) is difficult. We describe experiences implementing geriatric EDs that upgraded their accreditation level for the Geriatric Emergency Department Accreditation (GEDA) program. These can provide a model adopting sustaining guidelines evidence‐based care. Methods performed qualitative interviews with ED nurse physician leaders overseeing ED's processes. The interview guide was based on Consolidated Framework Research (CFIR), framework consisting comprehensive set factors impact implementation interventions. used inductive analysis to elucidate key themes from deductive map onto CFIR constructs. Results Clinician 15 19 status by March 1, 2023 participated interviews. Motivations upgrade centered improving patient (73%) achieving recognition (56%). Rationales choosing specific were more commonly related feasibility (40%) ability integrate into electronic health record (33%) than site‐specific needs (20%). Several common identified: (1) financing larger system or philanthropy crucial; (2) translating Guidelines clinical practice challenging clinician leaders; (3) motivational barriers existed among frontline staff; (4) longitudinal staff education needed given attrition turnover; (5) facilitated screenings. Conclusions involves significant time, resource allocation, commitment. pursuing balance aspirations improve availability implement competing priorities.

Language: Английский

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End‐of‐life emergency department use and healthcare expenditures among older adults: A nationally representative study

Journal of the American Geriatrics Society, Journal Year: 2024, Volume and Issue: unknown

Published: Sept. 23, 2024

Emergency department (ED) visits at end-of-life may cause financial strain and serve as a marker of inadequate access to community services health care. We sought examine ED use, total healthcare spending, out-of-pocket spending in nationally representative sample.

Language: Английский

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Do guidelines improve geriatric emergency care?

European Geriatric Medicine, Journal Year: 2024, Volume and Issue: unknown

Published: Oct. 15, 2024

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The geriatric emergency literature of note 2023

The American Journal of Emergency Medicine, Journal Year: 2024, Volume and Issue: 88, P. 34 - 44

Published: Nov. 12, 2024

Language: Английский

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Comparing Geriatric and Nongeriatric Emergency Departments: A First Step on a Critical Avenue of Research

Annals of Emergency Medicine, Journal Year: 2023, Volume and Issue: 82(6), P. 690 - 693

Published: Sept. 19, 2023

Language: Английский

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