Enhancing the Implementation, Effectiveness, and Reach of Geriatric Emergency Departments for Older Adults with Dementia (EMERGED)
Funded Grant
Overview
Affiliation
View All
Overview
description
PROJECT SUMMARY/ ABSTRACT One in four of the 6 million U.S. older adults with Alzheimer’s and related dementias (ADRD) is hospitalized from the Emergency Department (ED) each year. Evidence shows 11% of these ED hospitalizations are potentially avoidable; however, few interventions have effectively reduced ED hospitalizations among older adults with ADRD. Geriatric Emergency Departments (GEDs) are an innovative care delivery intervention shown to reduce ED hospitalization rates. However, the limited understanding of how GEDs work across the U.S., what care processes are most effective, and how best to implement GEDs are critical barriers to the continued adoption of this promising new intervention. To overcome these barriers, we will link national Medicare claims to detailed GED accreditation data to determine specific care processes associated with avoidable hospitalizations and identify best practices for GED implementation. We have assembled a team of experts in in emergency medicine, geriatrics, implementation science, and organizational behavior and developed a strategic research-practice partnership with the GED Accreditation program that will allow us to study GEDs with unprecedented depth and impact. In Aim 1, we will identify GED care processes adopted at high-performing GEDs with the largest reductions in hospitalizations and increases in hospital-free days within 30 days among older adults with ADRD. Next, we will use qualitative methods to compare barriers, facilitators, and organizational factors associated with GED implementation among high-performing GEDs, low-performing GEDs, and non-GEDs (Aim 2). Finally, we will translate our findings into a toolkit of feasible and high impact implementation strategies in partnership with the GED Accreditation program (Aim 3). Successful completion of these aims will result in a comprehensive understanding of effective GED care processes and an actionable toolkit of strategies to improve GED implementation and reduce avoidable hospitalization among older adults with ADRD. Our work is impactful and innovative because we will translate our findings to real-world outcomes using a research-practice partnership; apply expertise in organizational change to accelerate innovation adoption; and use novel, rigorous causal inference and implementation science methods. This proposal directly advances NIA ADRD milestones 13N and 13P to elucidate the mechanisms of health care utilization and quality and evaluate the impact of policies on persons living with ADRD and responds to the Notice of Special Interest (NOT-AG-21-046) on programs and services for persons with dementia. Our findings will inform future GED guidelines and catalyze the evidence-based adoption of care delivery innovations to reduce avoidable hospitalizations for the millions of older adults with ADRD who experience ED visits annually.
