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1. Perception of Treatment Success and Impact on Function with Antibiotics or Appendectomy for Appendicitis

Author

Thompson, Callie M, Voldal, Emily C, Davidson, Giana H, Sanchez, Sabrina E, Ayoung-Chee, Patricia, Victory, Jesse, Guiden, Mary, Bizzell, Bonnie, Glaser, Jacob, Hults, Christopher, Price, Thea P, Siparsky, Nicole, Ohe, Kristin, Mandell, Katherine A, DeUgarte, Daniel A, Kaji, Amy H, Uribe, Lisandra, Kao, Lillian S, Mueck, Krislynn M, Farjah, Farhood, Self, Wesley H, Clark, Sunday, Drake, F Thurston, Fischkoff, Katherine, Minko, Elizaveta, Cuschieri, Joseph, Faine, Brett, Skeete, Dionne A, Dhanani, Naila, Liang, Mike K, Krishnadasan, Anusha, Talan, David A, Fannon, Erin, Kessler, Larry G, Comstock, Bryan A, Heagerty, Patrick J, Monsell, Sarah E, Lawrence, Sarah O, Flum, David R, Lavallee, Danielle C, Parsons, Charles, Shapiro, Nathan I, Odom, Stephen R, Cooper, Randall, Tichter, Aleksandr, Hayward, Alyssa, Johnson, Jeffrey, Patton, Joe H, Hayes, Lillian Adrianna, Evans, Heather L, Arif, Hikmatullah, Hennessey, Laura, Fairfield, Cathy, Lew, Debbie, Bernardi, Karla, Olavarria, Oscar, Marquez, Stephanie, Ko, Tien C, McGrane, Karen, Sohn, Vance, Jones, Alan E, Patki, Deepti, Kutcher, Matthew E, Peacock, Rebekah K, Chung, Bruce, Carter, Damien W, MacKenzie, David, Burris, Debra, Mack, Joseph, Gerry, Terilee, Maggi, Jason, Pierce, Kristyn, Melis, Marcovalerio, Abouzeid, Mohamad, Shah, Paresh, Sinha, Prashant, Chiang, William, Rushing, Amy, Wisler, Jon, Steinberg, Steven, Tudor, Brandon, Foster, Careen S, Schaetzel, Shaina M, Morgan, Dayna, Tschirhart, John, Wallick, Julie, Martinez, Ryan, Wells, Sean, Ferrigno, Lisa, Salzberg, Matthew, Putnam, Brant, Kim, Dennis, Howell, Erin C, Spence, Lara H, Fleischman, Ross, Saltzman, Darin, Mireles, Debbie, Chen, Formosa, Moran, Gregory J, and Pathmarajah, Kavitha

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Clinical Trials and Supportive Activities, Comparative Effectiveness Research, patient-reported outcomes, appendicitis, appendectomy, antibiotics, sociodemographic factors, clinical factors, decisional regret, dissatisfaction with treatment, Comparison of Outcomes of antibiotic Drugs and Appendectomy, Writing Group for the CODA Collaborative:, Medical and Health Sciences, Surgery, Clinical sciences
Abstract

ObjectiveTo compare secondary patient reported outcomes of perceptions of treatment success and function for patients treated for appendicitis with appendectomy vs. antibiotics at 30 days.Summary background dataThe Comparison of Outcomes of antibiotic Drugs and Appendectomy trial found antibiotics noninferior to appendectomy based on 30-day health status. To address questions about outcomes among participants with lower socioeconomic status, we explored the relationship of sociodemographic and clinical factors and outcomes.MethodsWe focused on 4 patient reported outcomes at 30 days: high decisional regret, dissatisfaction with treatment, problems performing usual activities, and missing >10 days of work. The randomized (RCT) and observational cohorts were pooled for exploration of baseline factors. The RCT cohort alone was used for comparison of treatments. Logistic regression was used to assess associations.ResultsThe pooled cohort contained 2062 participants; 1552 from the RCT. Overall, regret and dissatisfaction were low whereas problems with usual activities and prolonged missed work occurred more frequently. In the RCT, those assigned to antibiotics had more regret (Odd ratios (OR) 2.97, 95% Confidence intervals (CI) 2.05-4.31) and dissatisfaction (OR 1.98, 95%CI 1.25-3.12), and reported less missed work (OR 0.39, 95%CI 0.27-0.56). Factors associated with function outcomes included sociodemographic and clinical variables for both treatment arms. Fewer factors were associated with dissatisfaction and regret.ConclusionsOverall, participants reported high satisfaction, low regret, and were frequently able to resume usual activities and return to work. When comparing treatments for appendicitis, no single measure defines success or failure for all people. The reported data may inform discussions regarding the most appropriate treatment for individuals.Trial registrationClinicaltrials.gov Identifier: NCT02800785.

Published
2023

2. Telehealth in emergency medicine: A consensus conference to map the intersection of telehealth and emergency medicine.

Author

Hayden, Emily, Davis, Christopher, Clark, Sunday, Joshi, Aditi, Krupinski, Elizabeth, Naik, Neel, Ward, Michael, Zachrison, Kori, Olsen, Erica, Chang, Bernard, Burner, Elizabeth, Greenwald, Peter, Chandra, Shruti, and Yadav, Kabir

Subjects
COVID-19, Consensus, Emergency Medicine, Humans, SARS-CoV-2, Telemedicine
Abstract

INTRODUCTION: Telehealth has the potential to significantly change the specialty of emergency medicine (EM) and has rapidly expanded in EM during the COVID pandemic; however, it is unclear how EM should intersect with telehealth. The field lacks a unified research agenda with priorities for scientific questions on telehealth in EM. METHODS: Through the 2020 Society for Academic Emergency Medicines annual consensus conference, experts in EM and telehealth created a research agenda for the topic. The multiyear process used a modified Delphi technique to develop research questions related to telehealth in EM. Research questions were excluded from the final research agenda if they did not meet a threshold of at least 80% of votes indicating important or very important. RESULTS: Round 1 of voting included 94 research questions, expanded to 103 questions in round 2 and refined to 36 questions for the final vote. Consensus occurred with a final set of 24 important research questions spanning five breakout group topics. Each breakout group domain was represented in the final set of questions. Examples of the questions include: Among underserved populations, what are mechanisms by which disparities in emergency care delivery may be exacerbated or ameliorated by telehealth (health care access) and In what situations should the quality and safety of telehealth be compared to in-person care and in what situations should it be compared to no care (quality and safety). CONCLUSION: The primary finding from the process was the breadth of gaps in the evidence for telehealth in EM and telehealth in general. Our consensus process identified priority research questions for the use of and evaluation of telehealth in EM to fill the current knowledge gaps. Support should be provided to answer the research questions to guide the evidenced-based development of telehealth in EM.

Published
2021

4. Factors associated with HIV testing among traditional healers and their clients in rural Uganda: Results from a cross-sectional study

Author

Nabukalu, Doreen, Ponticiello, Matthew, Bennett, Thomas, Clark, Sunday, King, Rachel, Mwanga-Amumpaire, Juliet, and Sundararajan, Radhika

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, HIV/AIDS, Clinical Trials and Supportive Activities, Sexually Transmitted Infections, Behavioral and Social Science, Infectious Diseases, Health Disparities, Clinical Research, Infection, Adult, Cross-Sectional Studies, Female, HIV Infections, HIV Testing, Humans, Male, Rural Population, Uganda, HIV, AIDS, prevention, Medical Microbiology, Public Health and Health Services, Public Health, Clinical sciences, Immunology
Abstract

Uptake of HIV testing is suboptimal in Uganda, particularly in rural communities. Reaching UNAIDS 95-95-95 goals requires strategies to increase HIV testing among hard-to-reach populations. This cross-sectional study sought to characterize engagement with HIV testing among traditional healers and their clients in rural Uganda. We enrolled 175 traditional healers and 392 adult clients of healers in Mbarara District. The primary outcome for this study was having received an HIV test in the prior 12 months. Most clients (n = 236, 65.9%) had received an HIV test within 12 months, compared to less than half of healers (n = 75, 46.3%) who had not. In multivariate regression models, male clients of healers were half as likely to have tested in the past year, compared with female (adjusted odds ratios (AORs) = 0.43, 95% CI = 0.26-0.70). Increasing age negatively predicted testing within the past year (AOR = 0.95, 95% CI = 0.93-0.97) for clients. Among healers, more sexual partners predicted knowing ones serostatus (AOR = 1.6, 95% CI 1.03-2.48). Healers (AOR = 1.16, 95% CI 1.07-1.26) and clients (AOR = 1.28, 95% CI 1.13-1.34 for clients) with greater numbers of lifetime HIV tests were more likely to have tested in the past year. Traditional healers and their clients lag behind UNAIDS benchmarks and would benefit from programs to increase HIV testing uptake.

Published
2021

5. Long-term Outcomes with Spinal versus General Anesthesia for Hip Fracture Surgery: A Randomized Trial

Author

Vail, Emily A., Feng, Rui, Sieber, Frederick, Carson, Jeffrey L., Ellenberg, Susan S., Magaziner, Jay, Dillane, Derek, Marcantonio, Edward R., Sessler, Daniel I., Ayad, Sabry, Stone, Trevor, Papp, Steven, Donegan, Derek, Mehta, Samir, Schwenk, Eric S., Marshall, Mitchell, Jaffe, J. Douglas, Luke, Charles, Sharma, Balram, Azim, Syed, Hymes, Robert, Chin, Ki-Jinn, Sheppard, Richard, Perlman, Barry, Sappenfield, Joshua, Hauck, Ellen, Tierney, Ann, Horan, Annamarie D., Neuman, Mark D., Looke, Thomas, Bent, Sandra, Franco-Mora, Ariana, Hedrick, Pamela, Newbern, Matthew, Tadros, Rafik, Pealer, Karen, Vlassakov, Kamen, Buckley, Carolyn, Gavin, Lauren, Gorbatov, Svetlana, Gosnell, James, Steen, Talora, Vafai, Avery, Zeballos, Jose, Hruslinski, Jennifer, Cardenas, Louis, Berry, Ashley, Getchell, John, Quercetti, Nicholas, Hassan, Manal, Bajracharya, Gauasan, Billow, Damien, Bloomfield, Michael, Cuko, Evis, Elyaderani, Mehrun K., Hampton, Robert, Honar, Hooman, Khoshknabi, Dilara, Kim, Daniel, Krahe, David, Lew, Michael M., Maheshwer, Conjeevram B., Niazi, Azfar, Saha, Partha, Salih, Ahmed, de Swart, Robert J., Volio, Andrew, Bolkus, Kelly, DeAngelis, Matthew, Dodson, Gregory, Gerritsen, Jeffrey, McEniry, Brian, Mitrev, Ludmil, Kwofie, M. Kwesi, Belliveau, Anne, Bonazza, Flynn, Lloyd, Vera, Panek, Izabela, Dabiri, Jared, Chavez, Chris, Craig, Jason, Davidson, Todd, Dietrichs, Chad, Fleetwood, Cheryl, Foley, Mike, Getto, Chris, Hailes, Susie, Hermes, Sarah, Hooper, Andy, Koener, Greg, Kohls, Kate, Law, Leslie, Lipp, Adam, Losey, Allison, Nelson, William, Nieto, Mario, Rogers, Pam, Rutman, Steve, Scales, Garrett, Sebastian, Barbara, Stanciu, Tom, Lobel, Gregg, Giampiccolo, Michelle, Herman, Dara, Kaufman, Margit, Murphy, Bryan, Pau, Clara, Puzio, Thomas, Veselsky, Marlene, Apostle, Kelly, Boyer, Dory, Chen Fan, Brenda, Lee, Susan, Lemke, Mike, Merchant, Richard, Moola, Farhad, Payne, Kyrsten, Perey, Bertrand, Viskontas, Darius, Poler, Mark, D’Antonio, Patricia, O’Neill, Greg, Abdullah, Amer, Fish-Fuhrmann, Jamie, Giska, Mark, Fidkowski, Christina, Guthrie, Stuart Trent, Hakeos, William, Hayes, Lillian, Hoegler, Joseph, Nowak, Katherine, Beck, Jeffery, Cuff, Jaslynn, Gaski, Greg, Haaser, Sharon, Holzman, Michael, Malekzadeh, A. Stephen, Ramsey, Lolita, Schulman, Jeff, Schwartzbach, Cary, Azefor, Tangwan, Davani, Arman, Jaberi, Mahmood, Masear, Courtney, Haider, Syed Basit, Chungu, Carolyn, Ebrahimi, Ali, Fikry, Karim, Marcantonio, Andrew, Shelvan, Anitha, Sanders, David, Clarke, Collin, Lawendy, Abdel, Schwartz, Gary, Garg, Mohit, Kim, Joseph, Caruci, Juan, Commeh, Ekow, Cuevas, Randy, Cuff, Germaine, Franco, Lola, Furgiuele, David, Giuca, Matthew, Allman, Melissa, Barzideh, Omid, Cossaro, James, D’Arduini, Armando, Farhi, Anita, Gould, Jason, Kafel, John, Patel, Anuj, Peller, Abraham, Reshef, Hadas, Safur, Mohammed, Toscano, Fiore, Tedore, Tiffany, Akerman, Michael, Brumberger, Eric, Clark, Sunday, Friedlander, Rachel, Jegarl, Anita, Lane, Joseph, Lyden, John P., Mehta, Nili, Murrell, Matthew T., Painter, Nathan, Ricci, William, Sbrollini, Kaitlyn, Sharma, Rahul, Steel, Peter A.D., Steinkamp, Michele, Weinberg, Roniel, Stephenson Wellman, David, Nader, Antoun, Fitzgerald, Paul, Ritz, Michaela, Bryson, Greg, Craig, Alexandra, Farhat, Cassandra, Gammon, Braden, Gofton, Wade, Harris, Nicole, Lalonde, Karl, Liew, Allan, Meulenkamp, Bradley, Sonnenburg, Kendra, Wai, Eugene, Wilkin, Geoffrey, Troxell, Karen, Alderfer, Mary Ellen, Brannen, Jason, Cupitt, Christopher, Gerhart, Stacy, McLin, Renee, Sheidy, Julie, Yurick, Katherine, Chen, Fei, Dragert, Karen, Kiss, Geza, Malveaux, Halina, McCloskey, Deborah, Mellender, Scott, Mungekar, Sagar S., Noveck, Helaine, Sagebien, Carlos, Biby, Luat, McKelvy, Gail, Richards, Anna, Abola, Ramon, Ayala, Brittney, Halper, Darcy, Mavarez, Ana, Rizwan, Sabeen, Choi, Stephen, Awad, Imad, Flynn, Brendan, Henry, Patrick, Jenkinson, Richard, Kaustov, Lilia, Lappin, Elizabeth, McHardy, Paul, Singh, Amara, Donnelly, Joanne, Gonzalez, Meera, Haydel, Christopher, Livelsberger, Jon, Pazionis, Theresa, Slattery, Bridget, Vazquez-Trejo, Maritza, Baratta, Jaime, Cirullo, Michael, Deiling, Brittany, Deschamps, Laura, Glick, Michael, Katz, Daniel, Krieg, James, Lessin, Jennifer, Mojica, Jeffrey, Torjman, Marc, Jin, Rongyu, Salpeter, Mary Jane, Powell, Mark, Simmons, Jeffrey, Lawson, Prentiss, Kukreja, Promil, Graves, Shanna, Sturdivant, Adam, Bryant, Ayesha, Crump, Sandra Joyce, Verrier, Michelle, Green, James, Menon, Matthew, Applegate, Richard, Arias, Ana, Pineiro, Natasha, Uppington, Jeffrey, Wolinsky, Phillip, Gunnett, Amy, Hagen, Jennifer, Harris, Sara, Hollen, Kevin, Holloway, Brian, Horodyski, Mary Beth, Pogue, Trevor, Ramani, Ramachandran, Smith, Cameron, Woods, Anna, Warrick, Matthew, Flynn, Kelly, Mongan, Paul, Ranganath, Yatish, Fernholz, Sean, Ingersoll-Weng, Esperanza, Marian, Anil, Seering, Melinda, Sibenaller, Zita, Stout, Lori, Wagner, Allison, Walter, Alicia, Wong, Cynthia, Orwig, Denise, Goud, Maithri, Helker, Chris, Mezenghie, Lydia, Montgomery, Brittany, Preston, Peter, Schwartz, J. Sanford, Weber, Ramona, Fleisher, Lee A., Mehta, Samir, Stephens-Shields, Alisa J., Dinh, Cassandra, Schwartz, Aron, Chelly, Jacques E., Goel, Shiv, Goncz, Wende, Kawabe, Touichi, Khetarpal, Sharad, Monroe, Amy, Shick, Vladislav, Breidenstein, Max, Dominick, Timothy, Friend, Alexander, Mathews, Donald, Lennertz, Richard, Sanders, Robert, Akere, Helen, Balweg, Tyler, Bo, Amber, Doro, Christopher, Goodspeed, David, Lang, Gerald, Parker, Maggie, Rettammel, Amy, Roth, Mary, White, Marissa, Whiting, Paul, Allen, Brian F.S., Baker, Tracie, Craven, Debra, McEvoy, Matt, Turnbo, Teresa, Kates, Stephen, Morgan, Melanie, Willoughby, Teresa, Weigel, Wade, Auyong, David, Fox, Ellie, Welsh, Tina, Cusson, Bruce, Dobson, Sean, Edwards, Christopher, Harris, Lynette, Henshaw, Daryl, Johnson, Kathleen, McKinney, Glen, Miller, Scott, Reynolds, Jon, Segal, B. Scott, Turner, Jimmy, VanEenenaam, David, Weller, Robert, Lei, Jineli, Treggiari, Miriam, Akhtar, Shamsuddin, Blessing, Marcelle, Johnson, Chanel, Kampp, Michael, Kunze, Kimberly, OʼConnor, Mary, Gaskins, Lakisha J., Looke, Thomas, Tadros, Rafik, Vlassakov, Kamen, Cardenas, Louis, Hassan, Manal, Bolkus, Kelly, Mitrev, Ludmil, Kwofie, M. Kwesi, Dabiri, Jared, Lobel, Gregg, Poler, Mark, Giska, Mark, Sanders, David, Schwartz, Gary, Giuca, Matthew, Tedore, Tiffany, Nader, Antoun, Papp, Stephen, Bryson, Greg, Troxell, Karen, Kiss, Geza, Choi, Stephen, Powell, Mark, Applegate, Richard, Warrick, Matthew, Ranganath, Yatish, Elkassabany, Nabil, Chelly, Jacques E., Hoeft, Mark A., Lennertz, Richard, Sanders, Robert, Allen, Brian F.S., Kates, Stephen, Weigel, Wade, Li, Jinlei, Wijeysundera, Duminda N., Kheterpal, Sachin, Moore, Reneé H., Smith, Alexander K., Tosi, Laura L., Elkassabany, Nabil, Looke, Thomas, Menio, Diane, Mehta, Samir, Fleisher, Lee, Menio, Diane, Hruslinski, Jennifer, Ramsey, Lolita, Gaskins, Lakisha J., Langlois, Christine, Gaskins, Lakisha J., Mezenghie, Lydia, Montgomery, Brittany, Oduwole, Samuel, and Rose, Thomas

Published
2024
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7. Geriatric Emergency Medicine Fellowships: Current State of Specialized Training for Emergency Physicians in Optimizing Care for Older Adults

Author

Rosen, Tony, Liu, Shan W, Cameron‐Comasco, Lauren, Clark, Sunday, Mulcare, Mary R, Biese, Kevin, Magidson, Phillip D, Tyler, Katren R, Melady, Don, Thatphet, Phraewa, Wongtangman, Thiti, Elder, Natalie M, Stern, Michael E, and Medicine, the Academy of Geriatric Emergency

Subjects
Curriculum and Pedagogy, Education, Aging, Clinical Research, Health Services, Emergency Care, Generic health relevance, Academy of Geriatric Emergency Medicine, Curriculum and pedagogy
Abstract

Improving emergency department (ED) care for older adults is a critical issue in emergency medicine. Institutions throughout the United States and Canada have recognized the growing need for a workforce of emergency physician (EP) leaders focused on clinical innovation, education, and research and have developed specialized fellowship training in geriatric emergency medicine (GEM). We describe here the overview, structure, and curricula of these fellowships as well as successes and challenges they have encountered. Seven GEM fellowships are active in the United States and Canada, with five offering postresidency training only, one offering fellowship training during residency only, and one offering both. The backbone of the curriculum for all fellowships is the achievement of core competencies in various aspects of GEM, and each includes clinical rotations, teaching, and a research project. Evaluation strategies and feedback have allowed for significant curricular changes as well as customization of the fellowship experience for individual fellows. Key successes include an improved collaborative relationship with geriatrics faculty that has led to additional initiatives and projects and former fellows already becoming regional and national leaders in GEM. The most critical challenges have been ensuring adequate funding and recruiting new fellows each year who are interested in this clinical area. We believe that interest in GEM fellowships will grow and that opportunities exist to combine GEM fellowship training with a focus in research, administration, or health policy to create unique new types of highly impactful specialized training. Future research may include exploring former fellows' postfellowship experiences, careers, accomplishments, and contributions to GEM to better understand the impact of GEM fellowships.

Published
2020

8. Developing a rigorous, systematic methodology to identify and categorize elder mistreatment in criminal justice data

Author

Dion, Sarah, Gogia, Kriti, Elman, Alyssa, Clark, Sunday, Ulrey, Page, Connolly, Marie-Therese, Lewis, Stuart, Bloemen, Elizabeth, LoFaso, Veronica M, Lachs, Mark S, Wartell, Julie, and Rosen, Tony

Subjects
Health Services and Systems, Nursing, Health Sciences, Violence Research, Behavioral and Social Science, Peace, Justice and Strong Institutions, Aged, Aged, 80 and over, Criminal Law, Elder Abuse, Female, Humans, Male, Middle Aged, Criminal justice elder abuse, elder mistreatment, methodology, prosecution, Medical and Health Sciences, Studies in Human Society, Psychology and Cognitive Sciences, Gerontology, Health services and systems
Abstract

Elder mistreatment is complex, with cases typically requiring integrated responses from social services, medicine, civil law, and criminal justice. Only limited research exists describing elder mistreatment prosecution and its impact. Researchers have not yet examined administrative prosecutorial data to explore mistreatment response, and no standardized analytic approach exists. We developed a rigorous, systematic methodologic approach to identify elder mistreatment cases in prosecutorial data from cases of crimes against victims aged ≥60. To do so, we operationalized elements of the accepted definition of elder mistreatment, including expectation of trust and vulnerability. We also designed an approach to categorize elder mistreatment cases, using the types of charges filed, into: financial exploitation, physical abuse, sexual abuse, verbal/emotional/psychological abuse, and neglect. This standardized methodological approach to identify and categorize elder mistreatment cases in prosecution data is an important preliminary step in analyzing this potentially untapped source of useful information about mistreatment response.

Published
2020

13. Perception of Treatment Success and Impact on Function with Antibiotics or Appendectomy for Appendicitis: A Randomized Clinical Trial with an Observational Cohort

Author

Thompson, Callie M., Voldal, Emily C., Davidson, Giana H., Sanchez, Sabrina E., Ayoung-Chee, Patricia, Victory, Jesse, Guiden, Mary, Bizzell, Bonnie, Glaser, Jacob, Hults, Christopher, Price, Thea P., Siparsky, Nicole, Ohe, Kristin, Mandell, Katherine A., DeUgarte, Daniel A., Kaji, Amy H., Uribe, Lisandra, Kao, Lillian S., Mueck, Krislynn M., Farjah, Farhood, Self, Wesley H., Clark, Sunday, Drake, F. Thurston, Fischkoff, Katherine, Minko, Elizaveta, Cuschieri, Joseph, Faine, Brett, Skeete, Dionne A., Dhanani, Naila, Liang, Mike K., Krishnadasan, Anusha, Talan, David A., Fannon, Erin, Kessler, Larry G., Comstock, Bryan A., Heagerty, Patrick J., Monsell, Sarah E., Lawrence, Sarah O., Flum, David R., and Lavallee, Danielle C.

Published
2022
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14. Engaging patients as partners in a multicentre trial of spinal versus general anaesthesia for older adults

Author

Looke, Thomas, Bent, Sandra, Franco-Mora, Ariana, Hedrick, Pamela, Newbern, Matthew, Tadros, Rafik, Pealer, Karen, Marcantonio, Edward, Vlassakov, Kamen, Buckley, Carolyn, Gorbatov, Svetlana, Gosnell, James, Steen, Talora, Vafai, Avery, Zeballos, Jose, Cardenas, Louis, Berry, Ashley, Getchell, John, Quercetti, Nicholas, Sessler, Daniel I., Ayad, Sabry, Hassan, Manal, Ali, Assad, Bajracharya, Gauasan, Billow, Damien, Bloomfield, Michael, Elliott, Kavita, Hampton, Robert, He, Linda, Honar, Hooman, Khoshknabi, Dilara, Kim, Daniel, Minko, Paul, Morris, Adam, Niazi, Azfar, Nutcharoen, Tara, Roberts, Jeffrey, Saha, Partha, Salih, Ahmed, Skolaris, Alexis, Stang, Taylor, Strimbu, Victor, Templeton, Jesse, Volio, Andrew, Wang, Jiayi, Bolkus, Kelly, DeAngelis, Matthew, Dodson, Gregory, Gerritsen, Jeffrey, McEniry, Brian, Mitrev, Ludmil, Kwofie, Kwesi, Bonazza, Flynn, Lloyd, Vera, Panek, Izabela, Dabiri, Jared, Chavez, Chris, Craig, Jason, Davidson, Todd, Dietrichs, Chad, Fleetwood, Cheryl, Foley, Mike, Getto, Chris, Hailes, Susie, Hermes, Sarah, Hooper, Andy, Koener, Greg, Kohls, Kate, Law, Leslie, Lipp, Adam, Losey, Allison, Nelson, William, Nieto, Mario, Rogers, Pam, Rutman, Steve, Scales, Garrett, Sebastian, Barbara, Stanciu, Tom, Lobel, Gregg, Giampiccolo, Michelle, Herman, Dara, Kaufman, Margit, Murphy, Bryan, Pau, Clara, Puzio, Thomas, Veselsky, Marlene, Stone, Trevor, Apostle, Kelly, Boyer, Dory, Fan, Brenda Chen, Lee, Susan, Lemke, Mike, Merchant, Richard, Moola, Farhad, Payne, Kyrsten, Perey, Bertrand, Viskontas, Darius, Poler, Mark, D'Antonio, Patricia, Sheppard, Richard, Abdullah, Amer, Fish-Fuhrmann, Jamie, Giska, Mark, Fidkowski, Christina, Guthrie, Trent, Hakeos, William, Hayes, Lillian, Hoegler, Joseph, Nowak, Katherine, Hymes, Robert, Beck, Jeffery, Cuff, Jaslynn, Gaski, Greg, Haaser, Sharon, Holzman, Michael, Malekzadeh, A. Stephen, Ramsey, Lolita, Schulman, Jeff, Schwartzbach, Cary, Sieber, Frederick, Azefor, Tangwan, Brown, Charles, Davani, Arman, Jaberi, Mahmood, Masear, Courtney, Sharma, Balram, Haider, Syed Basit, Chungu, Carolyn, Ebrahimi, Ali, Fikry, Karim, Gannon, Kerri, Marcantonio, Andrew, Pace, Meredith, Sanders, David, Clarke, Collin, Lawendy, Abdel, Schwartz, Gary, Garg, Mohit, Kim, Joseph, Marshall, Mitchell, Caurci, Juan, Commeh, Ekow, Cuevas, Randy, Cuff, Germaine, Franco, Lola, Furguiele, David, Giuca, Matthew, Allman, Melissa, Barzideh, Omid, Cossaro, James, D'Arduini, Armando, Farhi, Anita, Gould, Jason, Kafel, John, Patel, Anuj, Peller, Abraham, Reshef, Hadas, Safur, Mohammed, Toscano, Fiore, Tedore, Tiffany, Akerman, Michael, Brumberger, Eric, Clark, Sunday, Friedlander, Rachel, Jegarl, Anita, Lane, Joseph, Lyden, John P., Mehta, Nili, Murrell, Matthew T., Painter, Nathan, Ricci, William, Sbrollini, Kaitlyn, Sharma, Rahul, Steel, Peter A.D., Steinkamp, Michele, Weinberg, Roniel, Wellman, David Stephenson, Nader, Antoun, Fitzgerald, Paul, Ritz, Michaela, Papp, Steven, Bryson, Greg, Craig, Alexandra, Farhat, Cassandra, Gammon, Braden, Gofton, Wade, Harris, Nicole, Lalonde, Karl, Liew, Allan, Meulenkamp, Bradley, Sonnenburg, Kendra, Wai, Eugene, Wilkin, Geoffrey, Donegan, Derek, Dinh, Cassandra, Elkassabany, Nabil, Horan, Annamarie, Mehta, Samir, Troxell, Karen, Alderfer, Mary Ellen, Brannen, Jason, Cupitt, Christopher, Gerhart, Stacy, McLin, Renee, Sheidy, Julie, Yurick, Katherine, Carson, Jeffrey, Chen, Fei, Dragert, Karen, Kiss, Geza, Malveaux, Halina, McCloskey, Deborah, Mellender, Scott, Mungekar, Sagar S., Noveck, Helaine, Sagebien, Carlos, Perlman, Barry, Biby, Luat, McKelvy, Gail, Richards, Anna, Azim, Syed, Abola, Ramon, Ayala, Brittney, Halper, Darcy, Mavarez, Ana, Choi, Stephen, Awad, Imad, Flynn, Brendan, Henry, Patrick, Jenkinson, Richard, Kaustov, Lilia, Lappin, Elizabeth, McHardy, Paul, Singh, Amara, Hauck, Ellen, Donnelly, Joanne, Gonzalez, Meera, Haydel, Christopher, Livelsberger, Jon, Pazionis, Theresa, Slattery, Bridget, Vazquez-Trejo, Maritza, Schwenk, Eric, Baratta, Jaime, Deiling, Brittany, Deschamps, Laura, Glick, Michael, Katz, Daniel, Krieg, James, Lessin, Jennifer, Torjman, Marc, Chin, Ki Jinn, Jin, Rongyu, Salpeter, Mary Jane, Powell, Mark, Simmons, Jeffrey, Lawson, Prentiss, Kukreja, Promil, Graves, Shanna, Sturdivant, Adam, Bryant, Ayesha, Crump, Sandra Joyce, Dillane, Derek, Taylor, Michael, Verrier, Michelle, Applegate, Richard, Arias, Ana, Pineiro, Natasha, Uppington, Jeffrey, Wolinsky, Phillip, Sappenfield, Joshua, Gunnett, Amy, Hagen, Jennifer, Harris, Sara, Hollen, Kevin, Holloway, Brian, Horodyski, Mary Beth, Pogue, Trevor, Ramani, Ramachandran, Smith, Cameron, Woods, Anna, Warrick, Matthew, Flynn, Kelly, Mongan, Paul, Ranganath, Yatish, Fernholz, Sean, Ingersoll-Weng, Esperanza, Marian, Anil, Seering, Melinda, Sibenaller, Zita, Stout, Lori, Wagner, Allison, Walter, Alicia, Wong, Cynthia, Magaziner, Jay, Orwig, Denise, Brown, Trina, Dattilo, Jim, Ellenberg, Susan, Feng, Rui, Fleisher, Lee, Gaskins, Lakisha, Goud, Maithri, Helker, Chris, Mezenghie, Lydia, Montgomery, Brittany, Preston, Peter, Stephens, Alisa, Schwartz, J. Sanford, Tierney, Ann, Weber, Ramona, Chelly, Jacques, Goel, Shiv, Goncz, Wende, Kawabe, Touichi, Khetarpal, Sharad, King, Kevin, Kunkel, Frank, Luke, Charles, Monroe, Amy, Shick, Vladislav, Silipo, Anthony, Stehle, Caroline, Szabo, Katherine, Yennam, Sudhakar, Hoeft, Mark, Breidenstein, Max, Dominick, Timothy, Friend, Alexander, Mathews, Donald, Lennertz, Richard, Akere, Helen, Balweg, Tyler, Bo, Amber, Doro, Christopher, Goodspeed, David, Lang, Gerald, Parker, Maggie, Rettammel, Amy, Roth, Mary, Sanders, Robert, White, Marissa, Whiting, Paul, Allen, Brian, Baker, Tracie, Craven, Debra, McEvoy, Matt, Turnbo, Teresa, Kates, Stephen, Morgan, Melanie, Willoughby, Teresa, Weigel, Wade, Auyong, David, Fox, Ellie, Welsh, Tina, Jaffe, J. Douglas, Cusson, Bruce, Dobson, Sean, Edwards, Christopher, Harris, Lynette, Henshaw, Daryl, Johnson, Kathleen, McKinney, Glen, Miller, Scott, Reynolds, Jon, Turner, Jimmy, VanEenenaam, David, Weller, Robert, Akhtar, Shamsuddin, Blessing, Marcelle, Johnson, Chanel, Kampp, Michael, Kunze, Kimberly, Li, Jinlei, O'Connor, Mary, Treggiari, Miriam, Hruslinski, Jennifer, Menio, Diane A., Hymes, Robert A., Langlois, Christine, Gaskins, Lakisha J., and Neuman, Mark D.

Published
2021
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16. Rapid Primary Care Follow-up from the ED to Reduce Avoidable Hospital Admissions

Author

Carmel, Amanda S., Steel, Peter, Tanouye, Robert, Novikov, Aleksey, Clark, Sunday, Sinha, Sanjai, and Tung, Judy

Subjects
ED care transitions, primary care engagement
Abstract

Introduction: Hospital admissions from the emergency department (ED) now account forapproximately 50% of all admissions. Some patients admitted from the ED may not requireinpatient care if outpatient care could be optimized. However, access to primary care especiallyimmediately after ED discharge is challenging. Studies have not addressed the extent to whichhospital admissions from the ED may be averted with access to rapid (next business day)primary care follow-up. We evaluated the impact of an ED-to-rapid-primary-care protocol onavoidance of hospitalizations in a large, urban medical center.Methods: We conducted a retrospective review of patients referred from the ED to primary care(Weill Cornell Internal Medicine Associates – WCIMA) through a rapid-access-to-primary-careprogram developed at New York-Presbyterian / Weill Cornell Medical Center. Referrals wereclassified as either an avoided admission or not, and classifications were performed by bothemergency physician (EP) and internal medicine physician reviewers. We also collected outcomedata on rapid visit completion, ED revisits, hospitalizations and primary care engagement.Results: EPs classified 26 (16%) of referrals for rapid primary care fol low-up as avoidedadmissions. Of the 162 patients referred for rapid follow-up, 118 (73%) arrived for their rapidappointment. There were no differences in rates of ED revisits or subsequent hospitalizationsbetween those who attended the rapid follow-up and those who did not attend. Patients whoattended the rapid appointment were significantly more likely to attend at least one subsequentappointment at WCIMA during the six months after the index ED visit [N=55 (47%) vs. N=8(18%), P=0.001].Conclusion: A rapid-ED-to-primary-care-access program may allow EPs to avoid admittingpatients to the hospital without risking ED revisits or subsequent hospitalizations. This protocolhas the potential to save costs over time. A program such as this can also provide a safe andreliable ED discharge option that is also an effective mechanism for engaging patients in primarycare. [West J Emerg Med. 2017;18(5)870-877.]

Published
2017

17. Improving Quality of Acute Asthma Care in US Hospitals Changes Between 1999-2000 and 2012-2013

Author

Hasegawa, Kohei, Tsugawa, Yusuke, Clark, Sunday, Eastin, Carly D, Gabriel, Susan, Herrera, Vivian, Bittner, Jane C, Camargo, Carlos A, Investigators, MARC-37, Ahn, Jason, Aurora, Taruna, Brenner, Barry, Brown, Mark A, Calhoun, William, Gough, John E, Gharib, Asal, Heidt, Jonathan, Khosravi, Mehdi, Moore, Wendy C, Mould-Millman, Nee-Kofi, Nonas, Stephanie, Nowak, Richard, Pei, Veronica, Press, Valerie G, Probst, Beatrice D, Ramratnam, Sima K, Tallar, Matthew, Teuber, Suzanne S, Trent, Stacy A, Villarreal, Roberto, Watase, Taketo, and Youngquist, Scott

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Sciences, Lung, Clinical Research, Asthma, Patient Safety, Health and social care services research, 8.1 Organisation and delivery of services, Respiratory, Adolescent, Adult, Child, Preschool, Emergency Service, Hospital, Female, Guideline Adherence, Hospitalization, Humans, Length of Stay, Male, Middle Aged, Quality Improvement, Retrospective Studies, United States, asthma, guideline, hospitalization, quality of care, MARC-37 Investigators, Respiratory System, Cardiovascular medicine and haematology, Clinical sciences
Abstract

BackgroundLittle is known about the longitudinal change in the quality of acute asthma care for hospitalized children and adults in the United States. We investigated whether the concordance of inpatient asthma care with the national guidelines improved over time, identified hospital characteristics predictive of guideline concordance, and determined whether guideline-concordant care is associated with a shorter hospital length of stay (LOS).MethodsThis study was an analysis of data from two multicenter chart review studies of hospitalized patients aged 2 to 54 years with acute asthma during two time periods: 1999-2000 and 2012-2013. Outcomes were guideline concordance at the patient and hospital levels, and association of patient composite concordance with hospital LOS.ResultsThe analytic cohort for the comparison of guideline concordance comprised 1,634 patients: 834 patients from 1999-2000 vs 800 patients from 2012-2013. Over these 15 years, inpatient asthma care became more concordant at the hospital-level, with the mean composite score increasing from 74 to 82 (P < .001). However, during 2012-2013, wide variability in guideline concordance of acute asthma care remained across hospitals, with the greatest variation in provision of individualized written action plan at discharge (SD, 36). Guideline concordance was significantly lower in Midwestern and Southern hospitals compared with Northeastern hospitals. After adjusting for severity, patients who received care perfectly concordant with the guidelines had significantly shorter hospital LOS (-14% [95% CI, -23 to -4]; P = .009).ConclusionsBetween 1999 and 2013, the guideline concordance of acute asthma care for hospitalized patients improved. However, interhospital variability remains substantial. Greater concordance with evidence-based guidelines was associated with a shorter hospital LOS.

Published
2016

18. Changes in Emergency Department Concordance with Guidelines for the Management of Food-Induced Anaphylaxis: 1999-2001 versus 2013-2015

Author

Balekian, Diana S., Schrock, Jon, Vo, Phuong, Waseem, Muhammad, Baumann, Brigitte M., LoVecchio, Frank, Pierce, Ava E., Wojcik, Susan M., Gaeta, Theodore J., Jordan, Gait, del Portal, Daniel, Stiffler, Kirk A., Rowe, Brian H., Counselman, Francis L., Afilalo, Marc, Grimes, Quinn, Magee, Kirk, Clark, Sunday, Cephas, Jerome, Boggs, Krislyn M., Hasegawa, Kohei, and Camargo, Carlos A., Jr.

Published
2019
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19. Comparison of US emergency department acute asthma care quality: 1997-2001 and 2011-2012

Author

Hasegawa, Kohei, Sullivan, Ashley F, Tsugawa, Yusuke, Turner, Stuart J, Massaro, Susan, Clark, Sunday, Tsai, Chu-Lin, Camargo, Carlos A, and Investigators, MARC-36

Subjects
Emergency Care, Clinical Research, Lung, Health Services, Asthma, Adult, Emergency Service, Hospital, Emergency Treatment, Female, Guideline Adherence, Hospitalization, Humans, Male, Middle Aged, Practice Guidelines as Topic, Quality of Health Care, United States, Acute asthma, emergency department, guideline, concordance, quality of care, hospitalization, regional variation, time trend, MARC-36 Investigators, Immunology, Allergy
Abstract

BackgroundIt remains unclear whether the quality of acute asthma care in US emergency departments (EDs) has improved over time.ObjectivesWe investigated changes in concordance of ED asthma care with 2007 National Institutes of Health guidelines, identified ED characteristics predictive of concordance, and tested whether higher concordance was associated with lower risk of hospitalization.MethodsWe performed chart reviews in ED patients aged 18 to 54 years with asthma exacerbations in 48 EDs during 2 time periods: 1997-2001 (2 prior studies) and 2011-2012 (new study). Concordance with guideline recommendations was evaluated by using item-by-item quality measures and composite concordance scores at the patient and ED levels; these scores ranged from 0 to 100.ResultsThe analytic cohort comprised 4039 patients (2119 from 1997-2001 vs 1920 from 2011-2012). Over these 16 years, emergency asthma care became more concordant with level A recommendations at both the patient and ED levels (both P < .001). By contrast, concordance with non-level A recommendations (peak expiratory flow measurement and timeliness) decreased at both the patient (median score, 75 [interquartile range, 50-100] to 50 [interquartile range, 33-75], P < .001) and ED (mean score, 67 [SD, 7] to 50 [SD, 16], P < .001) levels. Multivariable analysis demonstrated ED concordance was lower in Southern and Western EDs compared with Midwestern EDs. After adjusting for severity, guideline-concordant care was associated with lower risk of hospitalization (odds ratio, 0.37; 95% CI, 0.26-0.53).ConclusionsBetween 1997 and 2012, we observed changes in the quality of emergency asthma care that differed by level of guideline recommendation and substantial interhospital and geographic variations. Greater concordance with guideline-recommended management might reduce unnecessary hospitalizations.

Published
2015

21. A Randomized Controlled Pilot Trial of the Functional Assessment Screening Tablet to Engage Patients at the Point of Care

Author

Hess, Rachel, Tindle, Hilary, Conroy, Molly B, Clark, Sunday, Yablonsky, Eric, and Hays, Ron D

Subjects
Biomedical and Clinical Sciences, Health Services and Systems, Public Health, Health Sciences, Clinical Sciences, Clinical Research, Clinical Trials and Supportive Activities, Health Services, Prevention, Cancer, Good Health and Well Being, Adult, Aged, Aged, 80 and over, Communication, Computers, Handheld, Feedback, Female, Health Behavior, Health Promotion, Humans, Male, Mass Screening, Middle Aged, Motor Activity, Philadelphia, Physician-Patient Relations, Pilot Projects, Point-of-Care Systems, Quality of Life, Smoking Cessation, Smoking Prevention, Young Adult, patient engagement, patient-centered outcomes research, smoking cessation, physical activity, quality of life, General & Internal Medicine, Clinical sciences, Health services and systems, Public health
Abstract

BackgroundHealthcare providers play an important role in encouraging healthy behaviors and improving health-related quality of life (HRQoL). They are most effective when they partner with informed, engaged patients.ObjectiveTo examine the impact of a new health-information technology intervention (FAST-Feedback) that provides patients with immediate, personalized, guideline-based feedback regarding tobacco use, physical activity, and HRQoL, and encourages patients to initiate discussions regarding these topics with their primary care physician.DesignA pilot, randomized controlled trial clustered by resident physician, with patients as the unit of analysis.ParticipantsResident physicians and their out-patients in a single academic health center between May and October 2011.InterventionPatients received (intervention) or did not receive (control) FAST-Feedback prior to the clinical encounter.Main outcome measuresPrimary outcomes were patient reports of initiating any discussions regarding tobacco use, physical activity, and HRQoL. Subgroup analyses examined patient reports of discussions regarding tobacco use, physical activity, and HRQoL, respectively.Key resultsThirty of the 36 eligible resident physicians (83%) agreed to participate; 173 of their 415 eligible patients (42%) expressed interest in the study and 99 (24%) consented to participate. Compared to controls, a higher percentage of intervention patients reported initiating any discussion with their resident physician, although this difference was not statistically significant (40% vs. 27%; p = 0.12). For subgroup analyses regarding specific topics of discussion, patients in the intervention group reported initiating more discussions regarding mental HRQoL than controls (23% vs. 0%; p = 0.02). There was no difference in patient reports of initiating discussions regarding smoking, physical activity or physical HRQoL.ConclusionsProviding patients with immediate, personalized, guideline-based feedback prior to the clinical encounter can increase patient-initiated discussions regarding mental HRQoL. Future work should test FAST-Feedback in a larger population and evaluate the impact on tobacco cessation, increased physical activity, and improvements in HRQoL.

Published
2014

22. Strategies for dissemination of ED/hospital elder mistreatment response team model.

Author

Bloemen, Elizabeth, Elman, Alyssa, Baek, Daniel, Gottesman, Elaine, Shaw, Amy, Sullivan, Michelle, Pino, Chloe, McAuley, Jennine, Tietz, Sarah, Herman, Seth, Rachmuth, Lisa, Chang, E-Shien, Hancock, David, LoFaso, Veronica M., Stern, Michael E., Lindberg, Dan, Clark, Sunday, and Rosen, Tony

Subjects
ELDER care, ABUSE of older people, EVALUATION of human services programs, HOSPITAL emergency services, MATHEMATICAL models, CONCEPTUAL structures, THEORY, HEALTH care teams
Abstract

Interdisciplinary Emergency Department/hospital-based teams represent a promising care model to improve identification of and intervention for elder mistreatment. Two institutions, Weill Cornell Medicine/NewYork-Presbyterian Hospital and the University of Colorado Anschutz Medical Campus have launched such programs and are exploring multiple strategies for effective dissemination. These strategies include: (1) program evaluation research, (2) framing as a new model of geriatric care, (3) understanding the existing incentives of health systems, EDs, and hospitals to align with them, (4) connecting to ongoing ED/hospital initiatives, (5) identifying and collaborating with communities with strong elder mistreatment response that want to integrate the ED/hospital, (6) developing and making easily accessible high-quality, comprehensive protocols and training materials, (7) offering technical assistance and support, (8) communications outreach to raise awareness, and (9) using an existing framework to inform implementation in new hospitals and health systems. [ABSTRACT FROM AUTHOR]

Published
2024
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23. The critical role of the specialized social worker as part of ED/hospital-based elder mistreatment response teams.

Author

Elman, Alyssa, Cox, Sarah, Gottesman, Elaine, Herman, Seth, Kirshner, Avery, Tietz, Sarah, Shaw, Amy, Hancock, David, Chang, E-Shien, Baek, Daniel, Bloemen, Elizabeth, Clark, Sunday, and Rosen, Tony

Subjects
ABUSE of older people, SOCIAL workers, OCCUPATIONAL roles, PATIENT safety, HOSPITAL emergency services, DECISION making, DISCHARGE planning, SOCIAL case work, COMMUNITY life, QUALITY of life, STAKEHOLDER analysis, HEALTH care teams, BIOPSYCHOSOCIAL model
Abstract

The emergency department and hospital provide a unique and important opportunity to identify elder mistreatment and offer intervention. To help manage these complex cases, multi-disciplinary response teams have been launched. In developing these teams, it quickly became clear that social workers play a critical role in responding to elder mistreatment. Their unique skillset allows them to establish close connections with community resources, collaborate with various hospital stakeholders, support patients/families/caregivers through challenging situations, navigate the legal and protective systems, and balance patient safety and quality of life in disposition decision-making. The role of the social worker on these multi-faceted teams includes conducting a comprehensive biopsychosocial assessment, helping to develop a safe discharge plan, and making appropriate referrals, among other responsibilities. Any institution considering developing a multi-disciplinary program should recognize the critical importance of social work. [ABSTRACT FROM AUTHOR]

Published
2024
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24. Changes in emergency department concordance with guidelines for the management of stinging insect-induced anaphylaxis: 1999–2001 vs 2013–2015

Author

Afilalo, Marc, Balekian, Diana S., Baumann, Brigitte M., Cephas, Jerome, Clark, Sunday, Counselman, Francis L., Gaeta, Theodore J., Grimes, Quinn, Jordan, Gait, LoVecchio, Frank, Magee, Kirk, Pierce, Ava E., Rowe, Brian H., Schrock, Jon, Stiffler, Kirk A., Vo, Phuong, Waseem, Muhammad, Wojcik, Susan M., Yeh, Ernest, Boggs, Krislyn M., Hasegawa, Kohei, and Camargo, Carlos A., Jr

Published
2018
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26. Initial steps in addressing the challenges of elder mistreatment evaluation: Protocol for evaluating the Vulnerable Elder Protection Team

Author

Baek, Daniel, primary, Elman, Alyssa, additional, Gottesman, Elaine, additional, Shaw, Amy, additional, Makaroun, Lena K, additional, Stern, Michael E, additional, Mulcare, Mary R, additional, Sullivan, Michelle, additional, Pino, Chloe, additional, McAuley, Jennine, additional, LoFaso, Veronica M, additional, Chang, E-Shien, additional, Hancock, David, additional, Bloemen, Elizabeth M, additional, Tietz, Sarah, additional, Lindberg, Daniel M, additional, Sharma, Rahul, additional, Clark, Sunday, additional, Lachs, Mark S, additional, Pillemer, Karl, additional, and Rosen, Tony, additional

Published
2023
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29. Improving Quality of Acute Asthma Care in US Hospitals: Changes Between 1999-2000 and 2012-2013

Author

Ahn, Jason, Aurora, Taruna, Brenner, Barry, Brown, Mark A., Calhoun, William, Gough, John E., Gharib, Asal, Heidt, Jonathan, Khosravi, Mehdi, Moore, Wendy C., Mould-Millman, Nee-Kofi, Nonas, Stephanie, Nowak, Richard, Pei, Veronica, Press, Valerie G., Probst, Beatrice D., Ramratnam, Sima K., Tallar, Matthew, Teuber, Suzanne S., Trent, Stacy A., Villarreal, Roberto, Watase, Taketo, Youngquist, Scott, Hasegawa, Kohei, Tsugawa, Yusuke, Clark, Sunday, Eastin, Carly D., Gabriel, Susan, Herrera, Vivian, Bittner, Jane C., and Camargo, Carlos A., Jr.

Published
2016
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32. Healthcare costs for legally adjudicated elder mistreatment victims in comparison to non‐mistreated older adults.

Author

Zhang, Hao, Bao, Yuhua, Baek, Daniel, Clark, Sunday, Elman, Alyssa, Hancock, David, Chang, E‐Shien, Jeng, Philip, Gassoumis, Zach, Fettig, Nicole, Zhang, Yiye, Wen, Katherine, Lachs, Mark S., Pillemer, Karl, and Rosen, Tony

Subjects
MEDICAL care costs, ACQUISITION of data, COMPARATIVE studies, HEALTH insurance reimbursement, ABUSE of older people, HEALTH insurance, RESEARCH funding, VICTIMS, MEDICARE, ECONOMICS
Abstract

Background: Elder mistreatment (EM) is associated with adverse health outcomes and healthcare utilization patterns that differ from other older adults. However, the association of EM with healthcare costs has not been examined. Our goal was to compare healthcare costs between legally adjudicated EM victims and controls. Methods: We used Medicare insurance claims to examine healthcare costs of EM victims in the 2 years surrounding initial mistreatment identification in comparison to matched controls. We adjusted costs using the Centers for Medicare and Medicaid Services Hierarchical Condition Categories (CMS‐HCC) risk score. Results: We examined healthcare costs in 114 individuals who experienced EM and 410 matched controls. Total Medicare Parts A and B healthcare costs were similar between cases and controls in the 12 months prior to initial EM detection ($11,673 vs. $11,402, p = 0.92), but cases had significantly higher total healthcare costs during the 12 months after initial mistreatment identification ($15,927 vs. $10,805, p = 0.04). Adjusting for CMS‐HCC scores, cases had, in the 12 months after initial EM identification, $5084 of additional total healthcare costs (95% confidence interval [$92, $10,077], p = 0.046) and $5817 of additional acute/subacute/post‐acute costs (95% confidence interval [$1271, $10,362], p = 0.012) compared with controls. The significantly higher total costs and acute/sub‐acute/post‐acute costs among EM victims in the post‐year were concentrated in the 120 days after EM detection. Conclusions: Older adults experiencing EM had substantially higher total costs during the 12 months after mistreatment identification, driven by an increase in acute/sub‐acute/post‐acute costs and focused on the period immediately after initial EM detection. [ABSTRACT FROM AUTHOR]

Published
2024
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33. Differences in antibiotic prescriptions between direct-to-consumer telehealth and telehealth in the emergency department.

Author

Yao, Peter, Gogia, Kriti, Clark, Sunday, Hsu, Hanson, Sharma, Rahul, and Greenwald, Peter

Subjects
HOSPITAL emergency services, DIRECT selling, MEDICAL care, RESPIRATORY infections, NOSOLOGY, EMERGENCY physicians
Abstract

Background: Telemedicine, which allows physicians to assess and treat patients via real-time audiovisual conferencing, is a rapidly growing modality for providing medical care. Antibiotic stewardship is one important measure of care quality, and research on antibiotic prescribing for acute respiratory infections in direct-to-consumer telemedicine has yielded mixed results. We compared antibiotic prescription rates for acute respiratory infections in two groups treated by telemedicine: (1) patients treated via a direct-to-consumer telemedicine application and (2) patients treated via telemedicine while physically inside the emergency department. Methods: We included direct-to-consumer telemedicine and emergency department telemedicine visits for patients 18 years and older with physician-coded International Classification of Diseases, Tenth Revision acute respiratory infection diagnoses between November 2016 and December 2018. Patients in both groups were seen by the same emergency department faculty working dedicated telemedicine shifts. We compared antibiotic prescribing rates for direct-to-consumer telemedicine and emergency department telemedicine visits before and after adjustment for age, sex, and diagnosis. Results: We identified a total of 468 acute respiratory infection visits: 191 direct-to-consumer telemedicine visits and 277 emergency department telemedicine visits. Overall, antibiotics were prescribed for 47% of visits (59% of direct-to-consumer telemedicine visits vs 39% of emergency department telemedicine visits; odds ratio 2.23; 95% confidence interval 1.53–3.25; P < 0.001). The difference in antibiotic prescribing rates remained significant after adjustment for age, sex, and diagnosis (odds ratio 2.49; 95% confidence interval 1.65–3.77; P < 0.001). Conclusion: Patients seen by the same group of physicians for acute respiratory infection were significantly more likely to be prescribed antibiotics by direct-to-consumer telemedicine care compared with telemedicine care in the emergency department. This work suggests that contextual factors rather than evaluation over video may contribute to differences in antibiotic stewardship for direct-to-consumer telemedicine encounters. [ABSTRACT FROM AUTHOR]

Published
2024
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40. Supplemental Material - Adult Protective Services Perspectives on Responding to Elder Abuse and Serving Clients During the COVID-19 Pandemic

Author

Elman, Alyssa, Gottesman, Elaine, Makaroun, Lena K., Chang, E-Shien, Baek, Daniel, Clark, Sunday, and Rosen, Tony

Subjects
FOS: Clinical medicine, 111799 Public Health and Health Services not elsewhere classified, FOS: Health sciences, 110306 Endocrinology, 110308 Geriatrics and Gerontology
Abstract

Supplemental Material for Adult Protective Services Perspectives on Responding to Elder Abuse and Serving Clients During the COVID-19 Pandemic by Alyssa Elman, Elaine Gottesman, Lena Makaroun, E-Shien Chang, Daniel Baek, Sunday Clark, and Tony Rosen in Journal of Applied Gerontology.

Published
2023
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41. Emergency Department and Hospital Utilization Among Older Adults Before and After Identification of Elder Mistreatment

Author

Rosen, Tony, primary, Zhang, Hao, additional, Wen, Katherine, additional, Clark, Sunday, additional, Elman, Alyssa, additional, Jeng, Philip, additional, Baek, Daniel, additional, Zhang, Yiye, additional, Gassoumis, Zach, additional, Fettig, Nicole, additional, Pillemer, Karl, additional, Lachs, Mark S., additional, and Bao, Yuhua, additional

Published
2023
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