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King BL, Meyer ML, Chari SV, Hurka-Richardson K, Bohrmann T, Chang PP, Rodgers JE, Busby-Whitehead J, Casey MF. Accuracy of the electronic health record's problem list in describing multimorbidity in patients with heart failure in the emergency department. PLoS One 2022; 17:e0279033. [PMID: 36512600 PMCID: PMC9747000 DOI: 10.1371/journal.pone.0279033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022] Open
Abstract
Patients with heart failure (HF) often suffer from multimorbidity. Rapid assessment of multimorbidity is important for minimizing the risk of harmful drug-disease and drug-drug interactions. We assessed the accuracy of using the electronic health record (EHR) problem list to identify comorbid conditions among patients with chronic HF in the emergency department (ED). A retrospective chart review study was performed on a random sample of 200 patients age ≥65 years with a diagnosis of HF presenting to an academic ED in 2019. We assessed participant chronic conditions using: (1) structured chart review (gold standard) and (2) an EHR-based algorithm using the problem list. Chronic conditions were classified into 37 disease domains using the Agency for Healthcare Research Quality's Elixhauser Comorbidity Software. For each disease domain, we report the sensitivity, specificity, positive predictive value, and negative predictive of using an EHR-based algorithm. We calculated the intra-class correlation coefficient (ICC) to assess overall agreement on Elixhauser domain count between chart review and problem list. Patients with HF had a mean of 5.4 chronic conditions (SD 2.1) in the chart review and a mean of 4.1 chronic conditions (SD 2.1) in the EHR-based problem list. The five most prevalent domains were uncomplicated hypertension (90%), obesity (42%), chronic pulmonary disease (38%), deficiency anemias (33%), and diabetes with chronic complications (30.5%). The positive predictive value and negative predictive value of using the EHR-based problem list was greater than 90% for 24/37 and 32/37 disease domains, respectively. The EHR-based problem list correctly identified 3.7 domains per patient and misclassified 2.0 domains per patient. Overall, the ICC in comparing Elixhauser domain count was 0.77 (95% CI: 0.71-0.82). The EHR-based problem list captures multimorbidity with moderate-to-good accuracy in patient with HF in the ED.
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Affiliation(s)
- Brandon L. King
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Michelle L. Meyer
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Srihari V. Chari
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Karen Hurka-Richardson
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Thomas Bohrmann
- Analytical Partners Consulting LLC, Raleigh, North Carolina, United States of America
| | - Patricia P. Chang
- Division of Cardiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Jo Ellen Rodgers
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina, United States of America
| | - Jan Busby-Whitehead
- Division of Geriatric Medicine and Center of Aging and Health, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Martin F. Casey
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
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Hurka-Richardson K, Platts-Mills TF, McLean SA, Weinberger M, Stearns SC, Bush M, Quackenbush E, Chari S, Aylward A, Kroenke K, Kerns RD, Weaver MA, Keefe FJ, Berkoff D, Meyer ML. Brief Educational Video plus Telecare to Enhance Recovery for Older Emergency Department Patients with Acute Musculoskeletal Pain: an update to the study protocol for a randomized controlled trial. Trials 2022; 23:400. [PMID: 35550175 PMCID: PMC9096747 DOI: 10.1186/s13063-022-06310-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background This update describes changes to the Brief Educational Tool to Enhance Recovery (BETTER) trial in response to the COVID-19 pandemic. Methods/design The original protocol was published in Trials. Due to the COVID-19 pandemic, the BETTER trial converted to remote recruitment in April 2020. All recruitment, consent, enrollment, and randomization now occur by phone within 24 h of the acute care visit. Other changes to the original protocol include an expansion of inclusion criteria and addition of new recruitment sites. To increase recruitment numbers, eligibility criteria were expanded to include individuals with chronic pain, non-daily opioid use within 2 weeks of enrollment, presenting musculoskeletal pain (MSP) symptoms for more than 1 week, hospitalization in past 30 days, and not the first time seeking medical treatment for presenting MSP pain. In addition, recruitment sites were expanded to other emergency departments and an orthopedic urgent care clinic. Conclusions Recruiting from an orthopedic urgent care clinic and transitioning to remote operations not only allowed for continued participant enrollment during the pandemic but also resulted in some favorable outcomes, including operational efficiencies, increased enrollment, and broader generalizability. Trial registration ClinicalTrials.gov NCT04118595. Registered on October 8, 2019.
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Affiliation(s)
- Karen Hurka-Richardson
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC, USA
| | | | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC, USA.,Department of Anesthesiology, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sally C Stearns
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Montika Bush
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC, USA
| | - Eugenia Quackenbush
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC, USA
| | - Srihari Chari
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC, USA
| | - Aileen Aylward
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC, USA
| | - Kurt Kroenke
- Regenstrief Institute and Department of Medicine, Indiana University, Indianapolis, IN, USA
| | - Robert D Kerns
- Departments of Psychiatry, Neurology and Psychology, Yale University, New Haven, CT, USA
| | - Mark A Weaver
- Department of Mathematics and Statistics, Elon University, Elon, NC, USA
| | - Francis J Keefe
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - David Berkoff
- Department of Orthopedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC, USA.
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Platts-Mills TF, Encarnacion JA, Bin Shams R, Hurka-Richardson K, Rosen T, Cannell B. Reliability of the longitudinal experts all data (LEAD) methodology for determining the presence of elder mistreatment. J Elder Abuse Negl 2021; 33:385-397. [PMID: 34878355 PMCID: PMC8881787 DOI: 10.1080/08946566.2021.2003278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Developing reliable screening tools to identify elder mistreatment requires an accurate and reproducible reference standard. This study sought to investigate the reliability of the Longitudinal, Experts, All Data (LEAD) methodology as a reference standard in confirming presence of elder mistreatment. We analyzed data from a large, emergency department-based study that used a LEAD panel to determine the reference standard. For this study, a second, blinded LEAD panel reviewed clinical material for 40 patients. For each panel, five content experts voted on whether elder mistreatment was present. We found moderate agreement between the two LEAD panels in determining presence of elder mistreatment: 85% agreement; k = 0.58; 95% Confidence Interval 0.28-0.87. Individual raters for both LEAD panels reported being mostly certain or certain >90% of votes. Efforts to further characterize and improve the reliability of the LEAD methodology in this context are warranted.
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Affiliation(s)
- Timothy F Platts-Mills
- Department of Emergency Medicine, University of North Carolina, Carrboro, North Carolina, USA
| | - John A Encarnacion
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Rayad Bin Shams
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Karen Hurka-Richardson
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Brad Cannell
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, Texas, USA
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Kayser J, Morrow-Howell N, Rosen TE, Skees S, Doering M, Clark S, Hurka-Richardson K, Bin Shams R, Ringer T, Hwang U, Platts-Mills TF, Network TG. Research priorities for elder abuse screening and intervention: A Geriatric Emergency Care Applied Research (GEAR) network scoping review and consensus statement. J Elder Abuse Negl 2021; 33:123-144. [PMID: 33797344 PMCID: PMC8204570 DOI: 10.1080/08946566.2021.1904313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The Geriatric Emergency Care Applied Research (GEAR) Network (1) conducted a scoping review of the current literature on the identification of and interventions to address elder abuse among patients receiving care in emergency departments and (2) used this review to prioritize research questions for knowledge development. Two questions guided the scoping review: What is the effect of universal emergency department screening compared to targeted screening or usual practice on cases of elder abuse identified, safety outcomes, and health care utilization?; and What is the safety, health, legal, and psychosocial impact of emergency department-based interventions vs. usual care for patients experiencing elder abuse? We searched five article databases. Additional material was located through reference lists of identified publications, PsychInfo, and Google Scholar. The results were discussed in a consensus conference; and stakeholders voted to prioritize research questions. No studies were identified that directly addressed the first question regarding assessment strategies, but four instruments used for elder abuse screening in the emergency department were identified. For the second question, we located six articles on interventions for elder abuse in the emergency department; however, none directly addressed the question of comparative effectiveness. Based on these findings, GEAR participants identified five questions as priorities for future research - two related to screening, two related to intervention, and one encompassed both. In sum, research to identify best practices for elder abuse assessment and intervention in emergency departments is still needed. Although there are practical and ethical challenges, rigorous experimental studies are needed.
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Affiliation(s)
- Jay Kayser
- School of Social Work, University of Michigan - Ann Arbor, Ann Arbor, Michigan, USA.,Department of Developmental Psychology, University of Michigan - Ann Arbor, Ann Arbor, Michigan, USA
| | - Nancy Morrow-Howell
- Brown School of Social Work, Washington University, St. Louis, Missouri, USA
| | - Tony E Rosen
- Department of Emergency Medicine, Weill Cornell Medicine, New York - Presbyterian Hospital, New York, USA
| | - Stephanie Skees
- Brown School of Social Work, Washington University, St. Louis, Missouri, USA
| | - Michelle Doering
- Becker Medical Library, Washington University, St Louis, Missouri, USA
| | - Sunday Clark
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Karen Hurka-Richardson
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Rayad Bin Shams
- Quantworks, Inc, Healthcare and Life Sciences, Carrboro, North Carolina, USA
| | - Thom Ringer
- Department of Emergency Medicine, Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, Ontario, Canada.,Department of Emergency Medicine, Schwartz/Reisman Emergency Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
| | - Ula Hwang
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Platts-Mills TF, Hurka-Richardson K, Shams RB, Aylward A, Dayaa JA, Manning M, Mosqueda L, Haukoos JS, Weaver MA, Sloane PD, Travers D, Hendry PL, Norse A, Jones CW, McLean SA, Reeve BB, Zimmerman S, Davenport K, Bynum D, Frederick E, Lassiter-Fisher K, Stuckey A, Daley-Placide R, Hoppens M, Betterton J, Owusu S, Flemming C, Colligan A. Multicenter Validation of an Emergency Department-Based Screening Tool to Identify Elder Abuse. Ann Emerg Med 2020; 76:280-290. [PMID: 32828327 DOI: 10.1016/j.annemergmed.2020.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/06/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE Emergency department (ED) visits provide an important opportunity for elder abuse identification. Our objective was to assess the accuracy of the ED Senior Abuse Identification (ED Senior AID) tool for the identification of elder abuse. METHODS We conducted a study of the ED Senior AID tool in 3 US EDs. Participants were English-speaking patients 65 years old and older who provided consent or for whom a legally authorized representative provided consent. Research nurses administered the screening tool, which includes a brief mental status assessment, questions about elder abuse, and a physical examination for patients who lack the ability to report abuse or for whom the presence or absence of abuse was uncertain. The reference standard was based on the majority opinion of a longitudinal, expert, all data (LEAD) panel following review and discussion of medical records, clinical social worker notes, and a structured social and behavioral evaluation. For the reference standard, LEAD panel members were blinded to the results of the screening tool. RESULTS Of 916 enrolled patients, 33 (3.6%) screened positive for elder abuse. The LEAD panel reviewed 125 cases: all 33 with positive screen results and a 10% random sample of negative screen results. Of these, the panel identified 17 cases as positive for elder abuse, including 16 of the 33 cases that screened positive. The ED Senior AID tool had a sensitivity of 94.1% (95% confidence interval [CI] 71.3% to 99.9%) and specificity of 84.3% (95% CI 76.0% to 90.6%). CONCLUSION This multicenter study found the ED Senior AID tool to have a high sensitivity and specificity as a screening tool for elder abuse, albeit with wide CIs.
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Affiliation(s)
- Timothy F Platts-Mills
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Karen Hurka-Richardson
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Rayad B Shams
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Aileen Aylward
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Joseph A Dayaa
- School of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Laura Mosqueda
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jason S Haukoos
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO
| | - Mark A Weaver
- Department of Mathematics and Statistics, Elon University, Elon, NC
| | - Philip D Sloane
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Debbie Travers
- School of Nursing, University of North Carolina, Chapel Hill, NC
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, FL
| | - Ashley Norse
- Department of Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, FL
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ
| | - Samuel A McLean
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Bryce B Reeve
- Department of Population Health Sciences, Duke University, Durham, NC
| | - Sheryl Zimmerman
- University of North Carolina School of Social Work, Chapel Hill, NC
| | | | - Katie Davenport
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Debra Bynum
- Department of Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | - Amy Stuckey
- University of North Carolina Healthcare, Chapel Hill, NC
| | | | - Mark Hoppens
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Judy Betterton
- University of North Carolina Healthcare, Chapel Hill, NC
| | - Samantha Owusu
- University of North Carolina Healthcare, Chapel Hill, NC
| | | | - Andrew Colligan
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ
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Platts-Mills TF, McLean SA, Weinberger M, Stearns SC, Bush M, Teresi BB, Hurka-Richardson K, Kroenke K, Kerns RD, Weaver MA, Keefe FJ. Brief educational video plus telecare to enhance recovery for older emergency department patients with acute musculoskeletal pain: study protocol for the BETTER randomized controlled trial. Trials 2020; 21:615. [PMID: 32631400 PMCID: PMC7336469 DOI: 10.1186/s13063-020-04552-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic musculoskeletal pain (MSP) affects more than 40% of adults aged 50 years and older and is the leading cause of disability in the USA. Older adults with chronic MSP are at risk for analgesic-related side effects, long-term opioid use, and functional decline. Recognizing the burden of chronic MSP, reducing the transition from acute to chronic pain is a public health priority. In this paper, we report the protocol for the Brief EducaTional Tool to Enhance Recovery (BETTER) trial. This trial compares two versions of an intervention to usual care for preventing the transition from acute to chronic MSP among older adults in the emergency department (ED). METHODS Three hundred sixty patients from the ED will be randomized to one of three arms: full intervention (an interactive educational video about pain medications and recovery-promoting behaviors, a telecare phone call from a nurse 48 to 72 h after discharge from the ED, and an electronic communication containing clinical information to the patient's primary care provider); video-only intervention (the interactive educational video but no telecare or primary care provider communication); or usual care. Data collection will occur at baseline and at 1 week and 1, 3, 6, and 12 months after study enrollment. The primary outcome is a composite measure of pain severity and interference. Secondary outcomes include physical function, overall health, opioid use, healthcare utilization, and an assessment of the economic value of the intervention. DISCUSSION This trial is the first patient-facing ED-based intervention aimed at helping older adults to better manage their MSP and reduce their risk of developing chronic pain. If effective, future studies will examine the effectiveness of implementation strategies. TRIAL REGISTRATION ClinicalTrials.gov NCT04118595 . Registered on 8 October 2019.
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Affiliation(s)
- Timothy F. Platts-Mills
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC 27599 USA
| | - Samuel A. McLean
- Department of Anesthesiology, University of North Carolina Hospitals, Chapel Hill, NC USA
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Sally C. Stearns
- Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Montika Bush
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC 27599 USA
| | - Brittni B. Teresi
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC 27599 USA
| | - Karen Hurka-Richardson
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC 27599 USA
| | - Kurt Kroenke
- Regenstrief Institute and Department of Medicine, Indiana University, Indianapolis, IN USA
| | | | - Mark A. Weaver
- Department of Mathematics and Statistics, Elon University, Elon, NC USA
| | - Francis J. Keefe
- Department of Psychology and Neuroscience, Duke University, Durham, NC USA
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Morris AM, Engelberg Anderson JK, Schmitthenner B, Aylward AF, Shams RB, Hurka-Richardson K, Platts-Mills TF. Leveraging emergency department visits to connect older adults at risk for malnutrition and food insecurity to community resources: design and protocol development for the BRIDGE study. Pilot Feasibility Stud 2020; 6:36. [PMID: 32158549 PMCID: PMC7055061 DOI: 10.1186/s40814-020-00576-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/17/2020] [Indexed: 12/17/2022] Open
Abstract
Background Malnutrition is a complex and costly condition that is common among older adults in the United States (US), with up to half at risk for malnutrition. Malnutrition is associated with several non-medical (i.e., social) factors, including food insecurity. Being at risk for both malnutrition and food insecurity likely identifies a subset of older adults with complex care needs and a high burden of social vulnerability (e.g., difficulty accessing or preparing meals, lack of transportation, and social isolation). US emergency departments (EDs) are a unique and important setting for identifying older patients who may benefit from the provision of health-related social services. This paper describes the protocol development for the Building Resilience and InDependence for Geriatric Patients in the Emergency Department (BRIDGE) study. BRIDGE was designed to assess the feasibility of an ED-based screening process to systematically identify older patients who are at risk for malnutrition and food insecurity and link them to health-related social services to address unmet social needs and support their health and well-being. Methods Phase 1 efforts will be formative and focused on identifying screening tools, establishing screening and referral workflows, and conducting initial feasibility testing with a cohort of older patients and ED staff. In phase 2, which includes process and outcome evaluation, the screening and referral process will be piloted in the ED. A partnership will be formed with an Area Agency on Aging (AAA) identified in phase 1, to assess resource needs and identify community-based social services for older ED patients who screen positive for both malnutrition risk and food insecurity. Data on screening, referrals, linkage to community-based social services, and patient-reported quality of life and healthcare utilization will be used to assess feasibility. Discussion The tools and workflows developed and tested in this study, as well as learnings related to forming and maintaining cross-sector partnerships, may serve as a model for future efforts to utilize EDs as a setting for bridging the gap between healthcare and social services for vulnerable patients.
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Affiliation(s)
| | | | | | - Aileen F Aylward
- 2Department of Emergency Medicine, University of North Carolina, 170 Manning Drive CB #7594, Chapel Hill, NC 27599 USA
| | - Rayad B Shams
- 2Department of Emergency Medicine, University of North Carolina, 170 Manning Drive CB #7594, Chapel Hill, NC 27599 USA
| | - Karen Hurka-Richardson
- 2Department of Emergency Medicine, University of North Carolina, 170 Manning Drive CB #7594, Chapel Hill, NC 27599 USA
| | - Timothy F Platts-Mills
- 2Department of Emergency Medicine, University of North Carolina, 170 Manning Drive CB #7594, Chapel Hill, NC 27599 USA
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