Improving the ED‐to‐Home Transition: The Community Paramedic–Delivered Care Transitions Intervention—Preliminary Findings

Shah, Manish N.; Hollander, Matthew M.; Jones, Courtney Marie Cora; Caprio, Thomas V.; Conwell, Yeates; Cushman, Jeremy T.; DuGoff, Eva H.; Kind, Amy; Lohmeier, Michael; Mi, Ranran; Coleman, Eric A.

doi:10.1111/jgs.15475

Cited by 35 publications

(34 citation statements)

References 43 publications

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“…Several intermediate care interventions delivered at home reported no evidence on length of hospital stay [56,57] or reduced hospital readmission rates [56,[58][59][60]. However, many combined interventions had positive effects on reducing short-term and long-term (re)hospitalisation rates [61][62][63][64][65][66][67][68][69] reducing ED visits [65], improving quality of life [61], and reducing costs [69].…”

Section: Intermediate Care Delivered At Homementioning

confidence: 99%

The effectiveness of intermediate care including transitional care interventions on function, healthcare utilisation and costs: a scoping review

et al. 2020

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Key summary points Aim This scoping review examined the effectiveness of intermediate care including transitional care interventions for middle-aged and older adults on function, healthcare utilisation, and costs. Findings While some studies report positive outcomes on hospital utilisation, the evidence is limited for their effectiveness on emergency department attendances, institutionalisation, function, and cost-effectiveness. Message Intermediate care including transitional care interventions were associated with reduced hospital stay but this finding was not universal. Electronic supplementary material The online version of this article (10.1007/s41999-020-00365-4) contains supplementary material, which is available to authorized users.

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Section: Intermediate Care Delivered At Homementioning

confidence: 99%

The effectiveness of intermediate care including transitional care interventions on function, healthcare utilisation and costs: a scoping review

et al. 2020

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“…Due to their low rates of knowledge, as well as their general risk factors of adverse outcomes, EDs and health systems should consider additional care transition supports to reinforce the information given at discharge. These supports may include follow‐up phone calls; telemedicine visits; or home visits from nurses, 60 community health workers, or community paramedics 61 . ED providers may also benefit from formal training on interpersonal and relational skills to enhance their ability to deliver and design patient‐centered discharge instructions in a meaningful manner 62,63 …”

Section: Discussionmentioning

confidence: 99%

Predictors of Older Adult Adherence With Emergency Department Discharge Instructions

Benjenk

DuGoff

Jacobsohn

et al. 2020

Academic Emergency Medicine

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Objective Older adults discharged from the emergency department (ED) are at high risk for adverse outcomes. Adherence to ED discharge instructions is necessary to reduce those risks. The objective of this study is to determine the individual‐level factors associated with adherence with ED discharge instructions among older adult ED outpatients. Methods We performed a secondary analysis of data from the control group of a randomized controlled trial testing a care transitions intervention among older adults (age ≥ 60 years) discharged home from the ED in two states. Taking data from patient surveys and chart reviews, we used multivariable logistic regression to identify patient characteristics associated with adherence to printed discharge instructions. Outcomes were patient‐reported medication adherence, provider follow‐up visit adherence, and knowledge of “red flags” (signs of worsening health requiring further medical attention). Results A total 824 patients were potentially eligible, and 699 had data in at least one pillar. A total of 35% adhered to medication instructions, 76% adhered to follow‐up instructions, and 35% recalled at least one red flag. In the multivariate analysis, no factors were significantly associated with failure to adhere to medications. Participants with poor health status (adjusted odds ratio [AOR] = 0.55, 95% confidence interval [CI] = 0.31 to 0.98) were less likely to adhere to follow‐up instructions. Participants who were older (AORs trended downward as age category increased) or depressed (AOR = 0.39, 95% CI = 0.17 to 0.85) or had one or more functional limitations (AOR = 0.62, 95% CI = 0.41 to 0.94) were less likely to recall red flags. Conclusion Older adults discharged home from the ED have mixed rates of adherence to discharge instructions. Although it is thought that some subgroups may be higher risk than others, given the opportunity to improve ED‐to‐home transitions, EDs and health systems should consider providing additional care transition support to all older adults discharged home from the ED.

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“…Follow-up and transitional care models have demonstrated efficacy in outcomes related to inpatient hospital discharges (Coleman, Parry, Chalmers, & Min, 2006). Recent research suggests innovative ED transitional care models show promise (Shah et al, 2018); however, to date the majority of GEDs have not focused on discharge follow-up.…”

Section: Discussionmentioning

confidence: 99%

Tracking the Rise of Geriatric Emergency Departments in the United States

et al. 2018

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The traditional model of emergency care no longer fits the growing needs of the over 20 million older adults annually seeking emergency department care. In 2007 a tailored “geriatric emergency department” model was introduced and rapidly replicated among hospitals, rising steeply over the past 5 years. This survey examined all U.S. emergency departments self-identifying themselves as Geriatric Emergency Departments (GEDs) and providing enhanced geriatric emergency care services. It was guided by the recently adopted Geriatric Emergency Department Guidelines and examined domains including, GED identity, staffing, and administration; education, equipment, and supplies; policies, procedures, and protocols; follow-up and transitions of care; and quality improvement. Results reveal a heterogeneous mix of GED staffing, procedures, physical environments and that GEDs’ familiarity with the GED Guidelines is low. Findings will inform emergency departments and gerontologists nationwide about key GED model elements and will help hospitals to improve ED services for their older adult patients.

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Improving the ED‐to‐Home Transition: The Community Paramedic–Delivered Care Transitions Intervention—Preliminary Findings

Cited by 35 publications

References 43 publications

The effectiveness of intermediate care including transitional care interventions on function, healthcare utilisation and costs: a scoping review

The effectiveness of intermediate care including transitional care interventions on function, healthcare utilisation and costs: a scoping review

Predictors of Older Adult Adherence With Emergency Department Discharge Instructions

Tracking the Rise of Geriatric Emergency Departments in the United States

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