Justine Seidenfeld, Karen M Stechuchak, Valerie A Smith, Catherine Stanwyck, Chelsea Perfect, Courtney Van Houtven, Susan Nicole Hastings
Introduction: Older adults were critically vulnerable to disruptions in health care during the COVID-19 pandemic, but it is not known if changes in ED utilization varied based on patient characteristics. Using a cohort of older Veterans, we examined changes in ED visit rates based on four characteristics of interest: age, race, area deprivation index, and frailty.
Methods: Participants were aged ≥65, with ≥2 visits in primary or geriatric clinics between 02/02/2018-05/07/2019. An adjusted negative binomial regression model was constructed for each characteristic. We report mean counts of all ED visits by quarter for subgroups separately, and report rate ratios to compare ED visits in the first year of the COVID-19 pandemic to the year before.
Results: Patients with complete case data numbered 38,871. During the first two quarters, all subgroups had decreased ED visits, with more variation in the third and fourth quarters. The very highly frail, who had the highest mean estimated count of ED visits per person through both pre-COVID and COVID periods, also had a significant decrease in their ED visits during multiple quarters of the pandemic to a greater degree than other frailty subgroups.
Conclusion: Stratifying older adults by frailty identified patient subgroups with the greatest variation in ED visits during COVID. Very highly frail patients warrant special attention to understand how variation in ED utilization affects patient outcomes.
{"title":"Frailty Explains Variation in Emergency Department Use for Older Veterans During the COVID-19 Pandemic.","authors":"Justine Seidenfeld, Karen M Stechuchak, Valerie A Smith, Catherine Stanwyck, Chelsea Perfect, Courtney Van Houtven, Susan Nicole Hastings","doi":"10.17294/2694-4715.1080","DOIUrl":"10.17294/2694-4715.1080","url":null,"abstract":"<p><strong>Introduction: </strong>Older adults were critically vulnerable to disruptions in health care during the COVID-19 pandemic, but it is not known if changes in ED utilization varied based on patient characteristics. Using a cohort of older Veterans, we examined changes in ED visit rates based on four characteristics of interest: age, race, area deprivation index, and frailty.</p><p><strong>Methods: </strong>Participants were aged ≥65, with ≥2 visits in primary or geriatric clinics between 02/02/2018-05/07/2019. An adjusted negative binomial regression model was constructed for each characteristic. We report mean counts of all ED visits by quarter for subgroups separately, and report rate ratios to compare ED visits in the first year of the COVID-19 pandemic to the year before.</p><p><strong>Results: </strong>Patients with complete case data numbered 38,871. During the first two quarters, all subgroups had decreased ED visits, with more variation in the third and fourth quarters. The very highly frail, who had the highest mean estimated count of ED visits per person through both pre-COVID and COVID periods, also had a significant decrease in their ED visits during multiple quarters of the pandemic to a greater degree than other frailty subgroups.</p><p><strong>Conclusion: </strong>Stratifying older adults by frailty identified patient subgroups with the greatest variation in ED visits during COVID. Very highly frail patients warrant special attention to understand how variation in ED utilization affects patient outcomes.</p>","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"5 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11378967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Geriatric Emergency Medicine Fellowship Journal Club – Community Paramedicine","authors":"Priyank Bhatnagar, Don Melady","doi":"10.17294/2694-4715.1077","DOIUrl":"https://doi.org/10.17294/2694-4715.1077","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"76 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141817847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Older Adult with Transplanted Kidney Failure from Ureteral Obstruction Within a Hernia","authors":"Joel Glotfelty, Hannah Grainger, Christina Shenvi","doi":"10.17294/2694-4715.1082","DOIUrl":"https://doi.org/10.17294/2694-4715.1082","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"102 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141657457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Bilateral corneal perforations due to elder neglect: a case report","authors":"Jaclyn Jordan, Katherine Selman, Richard Byrne","doi":"10.17294/2694-4715.1076","DOIUrl":"https://doi.org/10.17294/2694-4715.1076","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" 347","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141127690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Emergency Care of an Older Adult with Complex Care Needs","authors":"Muhammad Adnan Khan, Himika Dalia, Michelle Dietz","doi":"10.17294/2694-4715.1075","DOIUrl":"https://doi.org/10.17294/2694-4715.1075","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"46 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140978993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Best Practices in the Care of Older Adults During an Unplanned Acute Observation Stay","authors":"Jonny Macias Tejada, Michael Malone","doi":"10.17294/2694-4715.1079","DOIUrl":"https://doi.org/10.17294/2694-4715.1079","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" 33","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140996013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-12-16DOI: 10.17294/2694-4715.1100
Elina Kurkurina, Kimberly M Judon, Ula Hwang, Kenneth S Boockvar, Juan P Wisnivesky, Matthew R Augustine
Background: Older adults treated in emergency departments (EDs) are at higher risk for adverse outcomes. Using multiple facilities can worsen this issue through service duplication and poor care transitions. Veterans with dual insurance coverage can access both Veterans Health Administration (VHA) and non-VHA EDs. This study aimed to identify factors associated with non-VHA ED use among veterans.
Methods: We conducted a retrospective observational study of patients aged ≥ 65 who had primary care at the James J Peters VA Medical Center and at least one VHA or non-VHA ED visit between October 2017 and February 2020. Data were collected from the Veterans Affairs Corporate Data Warehouse and the Bronx Regional Health Information Exchange Organization. Generalized linear mixed models were used to examine factors influencing non-VHA ED use.
Results: The study sample consisted of 3,897 veterans and a total of 13,312 ED visits. Compared to VHA-exclusive ED users, non-VHA ED users were more likely to live farther away (OR 1.04, CI 1.02 - 1.06) and seek care outside regular hours, including mornings (OR 1.61, CI 1.39 - 1.87), nights (OR 1.49, CI 1.33 - 1.66), weekends (OR 1.28, CI 1.16 - 1.42), and holidays (OR 1.32, CI 1.04 - 1.68). They were also more likely to present with emergency care sensitive conditions (OR 2.13, CI 1.90 - 2.37) and recent inpatient hospitalizations (OR 1.22, CI 1.05 - 1.41).
Conclusion: These findings suggested that distance and acuity are important predictors of non-VHA ED use in urban areas such as the Bronx, NY. Identifying veterans with key risk factors could improve care coordination and potentially reduce non-VHA ED use.
{"title":"After-hours, Severity, and Distance are Associated with Non-VHA Emergency Department Use for Older Veterans: Insights from a Regional Health Information Exchange.","authors":"Elina Kurkurina, Kimberly M Judon, Ula Hwang, Kenneth S Boockvar, Juan P Wisnivesky, Matthew R Augustine","doi":"10.17294/2694-4715.1100","DOIUrl":"10.17294/2694-4715.1100","url":null,"abstract":"<p><strong>Background: </strong>Older adults treated in emergency departments (EDs) are at higher risk for adverse outcomes. Using multiple facilities can worsen this issue through service duplication and poor care transitions. Veterans with dual insurance coverage can access both Veterans Health Administration (VHA) and non-VHA EDs. This study aimed to identify factors associated with non-VHA ED use among veterans.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of patients aged ≥ 65 who had primary care at the James J Peters VA Medical Center and at least one VHA or non-VHA ED visit between October 2017 and February 2020. Data were collected from the Veterans Affairs Corporate Data Warehouse and the Bronx Regional Health Information Exchange Organization. Generalized linear mixed models were used to examine factors influencing non-VHA ED use.</p><p><strong>Results: </strong>The study sample consisted of 3,897 veterans and a total of 13,312 ED visits. Compared to VHA-exclusive ED users, non-VHA ED users were more likely to live farther away (OR 1.04, CI 1.02 - 1.06) and seek care outside regular hours, including mornings (OR 1.61, CI 1.39 - 1.87), nights (OR 1.49, CI 1.33 - 1.66), weekends (OR 1.28, CI 1.16 - 1.42), and holidays (OR 1.32, CI 1.04 - 1.68). They were also more likely to present with emergency care sensitive conditions (OR 2.13, CI 1.90 - 2.37) and recent inpatient hospitalizations (OR 1.22, CI 1.05 - 1.41).</p><p><strong>Conclusion: </strong>These findings suggested that distance and acuity are important predictors of non-VHA ED use in urban areas such as the Bronx, NY. Identifying veterans with key risk factors could improve care coordination and potentially reduce non-VHA ED use.</p>","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"5 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shan W Liu, Angel Li, Kei Ouchi, Carolina Diniz Hooper, Esteban Franco Garcia, Wendy C Coates
{"title":"Cultivating a Career in Geriatric Emergency Medicine.","authors":"Shan W Liu, Angel Li, Kei Ouchi, Carolina Diniz Hooper, Esteban Franco Garcia, Wendy C Coates","doi":"10.17294/2694-4715.1096","DOIUrl":"10.17294/2694-4715.1096","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"5 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthew B Downer, Kristina Kokorelias, Andrew P Costa, Don Melady, Samir K Sinha
{"title":"Describing and Predicting Trajectories of Healthcare Utilization Among Older Adults Presenting to an Emergency Department Using the interRAI Emergency Department Screener","authors":"Matthew B Downer, Kristina Kokorelias, Andrew P Costa, Don Melady, Samir K Sinha","doi":"10.17294/2694-4715.1072","DOIUrl":"https://doi.org/10.17294/2694-4715.1072","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"1 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139000397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Josette Hartnett, Isabel Muronzi-Belfon, Suzanne J. Rose
{"title":"Evaluation of a Community Based Teaching Hospital’s Geriatric Emergency Medicine Initiative","authors":"Josette Hartnett, Isabel Muronzi-Belfon, Suzanne J. Rose","doi":"10.17294/2694-4715.1065","DOIUrl":"https://doi.org/10.17294/2694-4715.1065","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"85 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138981813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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