Effects of a Geriatric Emergency Department Multidisciplinary Intervention on Functional Status and Quality of Life: A Pre/Post Cohort Study.

IF 3.2 3区 医学 Q1 EMERGENCY MEDICINE
Lauren T Southerland, Julie A Stephens, Katherine M Hunold, Christopher R Carpenter, Lorraine C Mion, Lucas Krupinski, Carson R Reider, Jeffrey M Caterino
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引用次数: 0

Abstract

Background: Geriatric screening and multidisciplinary assessment of older adults in the Emergency Department (ED) decrease hospitalizations and ED revisits. The impact on patient-reported outcomes of health-related quality of life (HRQoL) and functional status is not known.

Methods: A hybrid type II implementation/effectiveness prospective cohort study was conducted in an academic ED. The intervention bundle was geriatric screening for delirium, fall risk, and transition of care needs, and multidisciplinary assessment. All older adults (≥ 65 years) placed in the ED observation unit were eligible. HRQoL and functional status were obtained at the ED visit, 30, and 90 days, and were compared between the pre- and post-intervention implementation cohorts. Secondary outcomes included ED revisits, falls, mortality, and intervention adoption measures.

Results: From 2019 to 2023, 368 adults participated in the study: Most were community-dwelling (97%) and had multiple comorbidities. The pre (n = 138) and post (n = 230) cohorts did not differ in baseline functional status or HRQoL. The rate of geriatric screening improved from 12.3% in the pre-implementation cohort to 91.3% in the post-implementation cohort (p < 0.01). Multispecialty consultation also increased (68.1%-91.3%, p < 0.01). The proportion who had a post-ED visit decline in functional status did not differ between cohorts. Physical HRQoL declined similarly in both cohorts (-0.73 vs. -0.33, p = 0.61) at 90 days. Mental HRQoL improved in both cohorts; improvement was greater in the pre-cohort (2.35 vs. 0.32, p = 0.02). ED revisits and re-hospitalizations were unchanged (30 days: 23.0% vs. 17.2%, p = 0.18, and 90 days: 37.8% vs. 34.8%, p = 0.57). The intervention decreased falls at 30 and 90 days (30 days: 9.7% vs. 3.2%, p = 0.04; 90 days: 22.1% vs. 7.9%, p < 0.01).

Conclusions: Geriatric screening in the ED increased identification of geriatric syndromes and multidisciplinary consultation. The intervention was associated with decreased falls but did not affect HRQoL or reduce functional decline post ED visit.

Trial registration: clinicaltrials.gov: NCT04068311.

老年急诊科多学科干预对功能状态和生活质量的影响:一项前后队列研究
背景:老年筛查和多学科评估老年人在急诊科(ED)减少住院和急诊科就诊。对患者报告的健康相关生活质量(HRQoL)和功能状态的影响尚不清楚。方法:在一个学术急诊科进行了一项混合型实施/有效性前瞻性队列研究。干预措施包括谵妄、跌倒风险和护理需求转变的老年筛查,以及多学科评估。所有在急诊科观察单元的老年人(≥65岁)均符合条件。在ED就诊、30天和90天获得HRQoL和功能状态,并比较干预前和干预后的队列。次要结局包括急诊复诊、跌倒、死亡率和采取干预措施。结果:从2019年到2023年,368名成年人参与了这项研究:大多数是社区居民(97%),并有多种合并症。治疗前(n = 138)和治疗后(n = 230)的队列在基线功能状态和HRQoL方面没有差异。老年筛查率从实施前队列的12.3%提高到实施后队列的91.3% (p结论:急诊科的老年筛查增加了老年综合征的识别和多学科咨询。干预与减少跌倒有关,但不影响HRQoL或减少ED就诊后的功能下降。试验注册:clinicaltrials.gov: NCT04068311。
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来源期刊
Academic Emergency Medicine
Academic Emergency Medicine 医学-急救医学
CiteScore
7.60
自引率
6.80%
发文量
207
审稿时长
3-8 weeks
期刊介绍: Academic Emergency Medicine (AEM) is the official monthly publication of the Society for Academic Emergency Medicine (SAEM) and publishes information relevant to the practice, educational advancements, and investigation of emergency medicine. It is the second-largest peer-reviewed scientific journal in the specialty of emergency medicine. The goal of AEM is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to promote SAEM''s goals and objectives. Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, as well as for clinical news, case studies and more. Each issue contains information relevant to the research, educational advancements, and practice in emergency medicine. Subject matter is diverse, including preclinical studies, clinical topics, health policy, and educational methods. The research of SAEM members contributes significantly to the scientific content and development of the journal.
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