Care transition outcome measures of importance after emergency care: Do emergency clinicians and older adults agree?

Gettel, Cameron J.; Hwang, Ula; Rising, Kristin L; Goldberg, Elizabeth M.; Feder, Shelli; Uzamere, Ivie; Venkatesh, Arjun K.

doi:10.1111/acem.14732

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…This minimum age threshold was selected to maintain alignment with prior work in the field. 6,18,19 Studies were also required to report on at least one PROM assessment (as a primary or secondary outcome) after emergency care, defined as administration of a validated instrument for completion by the patient or their proxy. Studies could include subsets of both admitted and discharged patients from the ED, but only those studies that performed baseline measurements during the ED visit, as opposed to the inpatient setting, were included.…”

Section: Eligibility Criteriamentioning

confidence: 99%

“…16,17 Particularly after an acute health care event such as an ED visit, PROM assessments among older ED patients are critical given prior quantitative and qualitative work highlighting the population's unique prioritization of outcomes including functional status, disability, and QoL. [18][19][20] Barriers and best practices to PROM use have been described for the broader emergency care or hospital populations in existing reviews 21,22 ; however, a comprehensive review of PROM use in the older adult population following emergency care is missing. This information is critical to inform clinicians…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Gettel,

Galske,

Sather

et al. 2024

Academic Emergency Medicine

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

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Section: Eligibility Criteriamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Gettel,

Galske,

Sather

et al. 2024

Academic Emergency Medicine

Self Cite

View full text Add to dashboard Cite

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Perspectives from persons living with dementia and their caregivers on emergency department visits, care transitions, and outpatient follow‐up: A qualitative study

McHugh,

Muschong,

Bradley

et al. 2024

Academic Emergency Medicine

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BackgroundPersons living with dementia (PLWD) experience frequent and costly emergency department (ED) visits, with poor outcomes attributed to suboptimal care and postdischarge care transitions. Yet, patient‐centered data on ED care experiences and postdischarge needs are lacking. The objective of this study was to examine the facilitators and barriers to successful ED care and care transitions after discharge, according to PLWD and their caregivers.MethodsWe conducted a qualitative study involving ED patients ages 65 and older with confirmed or suspected dementia and their caregivers. The semistructured interview protocol followed the National Quality Forum's ED Transitions of Care Framework and addressed ED care, care transitions, and outpatient follow‐up care. Interviews were conducted during an ED visit at an urban, academic ED. Traditional thematic analysis was used to identify themes.ResultsWe interviewed 11 patients and 19 caregivers. Caregivers were more forthcoming than patients about facilitators and challenges experienced. Characteristics of the patients’ condition (e.g., resistance to care, forgetfulness), the availability of family resources (e.g., caregiver availability, primary care access), and system‐level factors (e.g., availability of timely appointments, hospital policies tailored to persons with dementia) served as facilitators and barriers to successful care. Some resources that would ameliorate care transition barriers could be easily provided in the ED, for example, offering clear discharge instructions and care coordination services and improving patient communication regarding disposition timeline. Other interventions would require investment from other parts of the health care system (e.g., respite for caregivers, broader insurance coverage).ConclusionsED care and care transitions for PLWD are suboptimal, and patient‐level factors may exacerbate existing system‐level deficiencies. Insight from patients and their caregivers may inform the development of ED interventions to design specialized care for this patient population. This qualitative study also demonstrated the feasibility of conducting ED‐based studies on PLWD during their ED visit.

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Caring for older adults' social needs in emergency departments: Where to draw the line?

Goldberg,

Bloemen,

Lindberg

2024

J American Geriatrics Society

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Care transition outcome measures of importance after emergency care: Do emergency clinicians and older adults agree?

Cited by 3 publications

References 9 publications

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

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

Perspectives from persons living with dementia and their caregivers on emergency department visits, care transitions, and outpatient follow‐up: A qualitative study

Caring for older adults' social needs in emergency departments: Where to draw the line?

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