Lauren T Southerland, Julie A Stephens, Katherine M Hunold, Christopher R Carpenter, Lorraine C Mion, Lucas Krupinski, Carson R Reider, Jeffrey M Caterino
{"title":"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","authors":"Lauren T Southerland, Julie A Stephens, Katherine M Hunold, Christopher R Carpenter, Lorraine C Mion, Lucas Krupinski, Carson R Reider, Jeffrey M Caterino","doi":"10.1111/acem.70119","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Trial registration: </strong>clinicaltrials.gov: NCT04068311.</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2000,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effects of a Geriatric Emergency Department Multidisciplinary Intervention on Functional Status and Quality of Life: A Pre/Post Cohort Study.\",\"authors\":\"Lauren T Southerland, Julie A Stephens, Katherine M Hunold, Christopher R Carpenter, Lorraine C Mion, Lucas Krupinski, Carson R Reider, Jeffrey M Caterino\",\"doi\":\"10.1111/acem.70119\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>Geriatric screening in the ED increased identification of geriatric syndromes and multidisciplinary consultation. 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Effects of a Geriatric Emergency Department Multidisciplinary Intervention on Functional Status and Quality of Life: A Pre/Post Cohort Study.
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.
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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