No abstract

Background We aim to describe the outcomes of Geriatric Emergency Room Innovations for Veterans (GERI‐VET), the first comprehensive Veterans Affairs Geriatric ED program. Methods In this prospective observational cohort study at an urban Veterans Affairs Medical Center ED, participants included Veterans aged 65 years and older treated in the ED from January 7, 2017 to February 29, 2020. Veterans with an Identification of Seniors At Risk (ISAR) score >2 were considered eligible for GERI‐VET, receiving geriatric screens and care coordination in addition to standard ED treatment. The control group included GERI‐VET eligible Veterans who did not receive GERI‐VET care. Propensity score matching was used to compare outcomes in the GERI‐VET group (N = 725) and a matched control group (n = 725). Key measures included ED resource utilization, outpatient referrals, ED admission, and 30‐day admission. Results In the ED, the GERI‐VET group received more consults to pharmacy (315 [43.4%] vs. 195 [26.9%], p < 0.001) and social work (399 [55.0%] vs. 132 [18.2%], p < 0.001). The GERI‐VET group had higher referral rates to Geriatrics (64 [17.7%] vs. 18 [5.8%], p < 0.001) and Home Based Primary Care (110 [30.4%] vs. 24 [7.8%], p < 0.001). Key outcome measures included lower rates of ED admission (363 [50.1%] vs. 417 [n = 57.5%], p = 0.003) and 30‐day hospital admission (412 [56.8%] vs. 464 [64.0%], p = 0.004) without increasing ED length of stay (5.4 ± 2.2 vs. 5.4 ± 2.6 h, p = 0.85) or 72‐h ED revisits (23 [3.2%] vs. 16 [2.2%], p = 0.25) in the GERI‐VET group. Conclusions A program designed to screen for geriatric syndromes and coordinate care among at‐risk older Veterans was associated with increased multidisciplinary resource utilization and reduced ED and 30‐day admissions without increasing ED length of stay or re‐visitation.

Objective To describe a feasibility pilot study for older adults that addresses the digital divide, unmet health care needs, and the 4Ms of Age‐Friendly Health Systems via the emergency department (ED) follow‐up home visits supported by telehealth. Data Sources and Study Setting Data sources were a pre‐implementation site survey and pilot phase individual‐level patient data from six US Department of Veterans Affairs (VA) EDs. Study Design A pre‐implementation survey assessed existing geriatric ED processes. In the pilot called SCOUTS (Supporting Community Outpatient, Urgent care & Telehealth Services), sites identified high‐risk patients during an ED visit. After ED discharge, Intermediate Care Technicians (ICTs, former military medics), performed follow‐up telephone, or home visits. During the follow‐up visit, ICTs identified “what matters,” performed geriatric screens aligned with Age‐Friendly Health Systems, observed home safety risks, assisted with video telehealth check‐ins with ED providers, and provided care coordination. SCOUTS visit data were recorded in the patient's electronic medical record using a standardized template. Data Collection/Extraction Methods Sites were surveyed via electronic form. Administrative pilot data extracted from VA Corporate Data Warehouse, May–October 2021. Principle Findings Site surveys showed none of the EDs had a formalized way of identifying the 4 M “what matters.” During the pilot, ICT performed 56 telephone and 247 home visits. All home visits included a telehealth visit with an ED provider (n = 244) or geriatrician (n = 3). ICTs identified 44 modifiable home fall risks and 99 unmet care needs, recommended 80 pieces of medical equipment, placed 36 specialty care consults, and connected 180 patients to a Patient Aligned Care Team member for follow‐up. Conclusions A post‐ED follow‐up program in which former military medics perform geriatric screens and care coordination is feasible. Combining telehealth and home visits allows providers to address what matters and unmet care needs.