Jaime M Hughes1,2,3, Caroline E Freiermuth4, Megan Shepherd-Banigan1,2, Luna Ragsdale4, Stephanie A Eucker4, Karen Goldstein1,5, S Nicole Hastings1,2,3,6, Rachel L Rodriguez7, Jessica Fulton7, Katherine Ramos1,3,6, Amir Alishahi Tabriz8, Adelaide M Gordon1, Jennifer M Gierisch1,2,5, Andrzej Kosinski9, John W Williams1,5. 1. Center for Health Services Research in Primary Care, Durham VA Health Care System, Durham, North Carolina. 2. Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina. 3. Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina. 4. Division of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina. 5. Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina. 6. Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, North Carolina. 7. Psychology Service, Durham VA Health Care System, Durham, North Carolina. 8. Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina. 9. Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina.
Abstract
OBJECTIVES: To evaluate the effect of emergency department (ED) interventions on clinical, utilization, and care experience outcomes for older adults. DESIGN: A conceptual model informed, protocol-based systematic review. SETTING: Emergency Department (ED). PARTICIPANTS: Older adults 65 years of age and older. METHODS AND MEASUREMENT: Medline, Embase, CINAHL, and PsycINFO were searched for English-language studies published through December 2017. Studies evaluating the use of one or more eligible intervention strategies (discharge planning, case management, medication safety or management, and geriatric EDs including those that cited the 2014 Geriatric ED Guidelines) with adults 65 years of age and older were included. Studies were classified by the number of intervention strategies used (ie, single strategy or multi-strategy) and key intervention components present (ie, assessment, referral plus follow-up, and contact both before and after ED discharge ["bridge"]). The effect of ED interventions on clinical (functional status, quality of life [QOL]), patient experience, and utilization (hospitalization, ED return visit) outcomes was evaluated. RESULTS: A total of 2000 citations were identified; 17 articles describing 15 unique studies (9 randomized and 6 nonrandomized) met eligibility criteria and were included in analyses. ED interventions showed a mixed pattern of effects. Overall, there was a small positive effect of ED interventions on functional status but no effects on QOL, patient experience, hospitalization at or after the initial ED index visit, or ED return visit. CONCLUSION: Studies using two or more intervention strategies may be associated with the greatest effects on clinical and utilization outcomes. More comprehensive interventions, defined as those with all three key intervention components present, may be associated with some positive outcomes.
OBJECTIVES: To evaluate the effect of emergency department (ED) interventions on clinical, utilization, and care experience outcomes for older adults. DESIGN: A conceptual model informed, protocol-based systematic review. SETTING: Emergency Department (ED). PARTICIPANTS: Older adults 65 years of age and older. METHODS AND MEASUREMENT: Medline, Embase, CINAHL, and PsycINFO were searched for English-language studies published through December 2017. Studies evaluating the use of one or more eligible intervention strategies (discharge planning, case management, medication safety or management, and geriatric EDs including those that cited the 2014 Geriatric ED Guidelines) with adults 65 years of age and older were included. Studies were classified by the number of intervention strategies used (ie, single strategy or multi-strategy) and key intervention components present (ie, assessment, referral plus follow-up, and contact both before and after ED discharge ["bridge"]). The effect of ED interventions on clinical (functional status, quality of life [QOL]), patient experience, and utilization (hospitalization, ED return visit) outcomes was evaluated. RESULTS: A total of 2000 citations were identified; 17 articles describing 15 unique studies (9 randomized and 6 nonrandomized) met eligibility criteria and were included in analyses. ED interventions showed a mixed pattern of effects. Overall, there was a small positive effect of ED interventions on functional status but no effects on QOL, patient experience, hospitalization at or after the initial ED index visit, or ED return visit. CONCLUSION: Studies using two or more intervention strategies may be associated with the greatest effects on clinical and utilization outcomes. More comprehensive interventions, defined as those with all three key intervention components present, may be associated with some positive outcomes.
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