Featured Publications
Detecting Cognitive Impairment and Dementia in the Emergency Department: A Scoping Review
Nowroozpoor A, Dussetschleger J, Perry W, Sano M, Aloysi A, Belleville M, Brackett A, Hirshon JM, Hung W, Moccia JM, Ohuabunwa U, Shah MN, Hwang U, Network G, Aggarwal N, Bellolio M, Betz M, Biese K, Brandt C, Bruursema S, Carnahan R, Carpenter C, Carr D, Chin-Hansen J, Daven M, Degesys N, Dresden S, Ellenbogen M, Falvey J, Foster B, Gettel C, Gilmore-Bykovskyi A, Goldberg E, Han J, Hardy J, Hastings S, Hogan T, Isaacs E, Jaspal N, Johnson J, Kelly K, Kennedy M, Kind A, Malone M, Moreno M, Morrow-Howell N, Oiyemhonlan B, Resendez J, Rising K, Savage B, Suyama J, Swartzberg J, Tolia V, Vann A, Webb T, Weintraub S. Detecting Cognitive Impairment and Dementia in the Emergency Department: A Scoping Review. Journal Of The American Medical Directors Association 2022, 23: 1314-1315.e55. PMID: 35940682, PMCID: PMC10804640, DOI: 10.1016/j.jamda.2022.03.019.Peer-Reviewed Original ResearchConceptsSix-Item ScreenerEmergency departmentCognitive impairmentED settingConsensus conferenceScoping ReviewHigh negative predictive valueAdult ED patientsNegative predictive valueMedical research databasesOttawa 3DYSystematic scoping reviewED patientsResearch funding prioritiesClinical careResearch DatabasePredictive valueCare partnersResearch prioritiesDementiaImpairmentConsensus processPractice gapTask ForceFuture research prioritiesThe Geriatric Emergency Care Applied Research (GEAR) network approach: a protocol to advance stakeholder consensus and research priorities in geriatrics and dementia care in the emergency department
Hwang U, Carpenter C, Dresden S, Dussetschleger J, Gifford A, Hoang L, Leggett J, Nowroozpoor A, Taylor Z, Shah M, Bellolio M, Biese K, Binkley C, Bott N, Brody A, Carpenter C, Clark S, Dresden S, Forester S, Gettel C, Goldberg E, Greenberg A, Hammouda N, Han J, Hastings N, Hogan T, Hung W, Hwang U, Kayser J, Kennedy M, Ko K, Lesser A, Linton E, Liu S, Malsch A, Melady C, Morrow-Howell N, Nassisi D, Nerbonne L, Nyamu S, Ohuabunwa U, Platts-Mills T, Ragsdale L, Richardson L, Ringer T, Rosen A, Rosenberg M, Shah M, Skains R, Skees S, Souffront K, Stabler L, Sullivan C, Suyama J, Vargas S, Vaughan E, Voils C, Wei D, Allore H, Aloysi A, Belleville M, Bellolio M, Betz M, Biese K, Brandt C, Carnahan R, Carr D, Chin-Hansen J, Daven M, Degesys N, Ellenbogen M, Escobedo M, Falvey J, Gill T, Gilmore-Bykovskyi A, Goldberg E, Han J, Hardy J, Hastings S, Hirshon J, Hogan T, Hung W, Isaacs E, Kelly K, Kennedy M, Kind A, Malicki C, Malone M, Marottoli R, Moccia M, Mor V, Morris J, Howell N, Nowroozpoor A, Ohuabunwa U, Oiyemhonlan B, Perry W, Raven M, Rising K, Sano M, Stabler L, Sullivan C, Suyama J, Swartzberg J, Tolia V, Vann A, Weintraub S, Zieman S, Dussetschleger J, Gifford A, Leggett J, Nowroozpoor A, Taylor Z. The Geriatric Emergency Care Applied Research (GEAR) network approach: a protocol to advance stakeholder consensus and research priorities in geriatrics and dementia care in the emergency department. BMJ Open 2022, 12: e060974. PMID: 35459682, PMCID: PMC9036447, DOI: 10.1136/bmjopen-2022-060974.Peer-Reviewed Original ResearchConceptsEmergency departmentOlder adultsEmergency careEmergency care needsGeriatric emergency carePriority topic areasPeer-reviewed journalsClinical gapsCare needsResearch prioritiesCare partnersConsensus workshopSystematic reviewHealthcare needsDementia careIntervention impactDissemination of findingsTrial evaluationCareImplementation scienceAdultsResearch NetworkReviewStandardised searchHuman subjects research
2024
Screening for cognitive impairment in the emergency department: agreement between older adult patient- and informant-completed Ascertain Dementia 8 tool.
Galske J, Sather A, Chera T, Hwang U, Carpenter C, Babcock M, Gettel C. Screening for cognitive impairment in the emergency department: agreement between older adult patient- and informant-completed Ascertain Dementia 8 tool. Dementia And Geriatric Cognitive Disorders 2024, 1-13. PMID: 39616991, DOI: 10.1159/000542895.Peer-Reviewed Original ResearchAscertain Dementia 8Intraclass correlation coefficientEmergency departmentCognitive impairmentTrained research assistantsDiagnosis of dementiaClinicians providing careModerate agreementSuspected CIEmergency careOlder adultsAnalytic sampleResearch assistantsED patientsCareScreening protocolSelf-identifyEarly interventionDementiaScoresCorrelation coefficientDepartmentDyadsPatientsImpairmentEnd‐of‐life emergency department use and healthcare expenditures among older adults: A nationally representative study
Gettel C, Kitchen C, Rothenberg C, Song Y, Hastings S, Kennedy M, Ouchi K, Haimovich A, Hwang U, Venkatesh A. End‐of‐life emergency department use and healthcare expenditures among older adults: A nationally representative study. Journal Of The American Geriatrics Society 2024 PMID: 39311623, DOI: 10.1111/jgs.19199.Peer-Reviewed Original ResearchEnd-of-lifeOut-of-pocket spendingED visitsTotal healthcare spendingMedicare beneficiariesHealthcare spendingEmergency departmentOlder adultsMedicare Current Beneficiary Survey dataAnalysis of Medicare beneficiariesPooled cross-sectional analysisEmergency department usePrimary outcomeDecreased likelihoodDiagnosis of dementiaOut-of-pocket costsNationally representative studyNationally representative sampleAdult decedentsHospice statusDepartment useED useED servicesHealth careHealthcare expendituresRacial, Ethnic, and Age-Related Disparities in Sedation and Restraint Use for Older Adults in the Emergency Department
Jivalagian P, Gettel C, Smith C, Robinson L, Brinker M, Shah D, Kumar A, Faustino I, Nath B, Chang-Sing E, Taylor R, Kennedy M, Hwang U, Wong A. Racial, Ethnic, and Age-Related Disparities in Sedation and Restraint Use for Older Adults in the Emergency Department. American Journal Of Geriatric Psychiatry 2024 PMID: 39054237, DOI: 10.1016/j.jagp.2024.07.004.Peer-Reviewed Original ResearchPhysical restraint useRestraint useOlder adultsED visitsPhysical restraintEmergency departmentElectronic health record dataHealth record dataBlack non-HispanicPatient-level characteristicsAge-related disparitiesAssociated with increased useRegional hospital networkCross-sectional studyLogistic regression modelsChemical sedationRetrospective cross-sectional studyNon-Hispanic groupNon-HispanicAgitation managementHospital sitesHospital networkRecord dataWhite non-Hispanic groupPrimary outcomeTotal and Out-of-Pocket Costs Surrounding Emergency Department Care Among Older Adults Enrolled in Traditional Medicare and Medicare Advantage
Gettel C, Salah W, Rothenberg C, Liang Y, Schwartz H, Scott K, Hwang U, Hastings S, Venkatesh A. Total and Out-of-Pocket Costs Surrounding Emergency Department Care Among Older Adults Enrolled in Traditional Medicare and Medicare Advantage. Annals Of Emergency Medicine 2024, 84: 285-294. PMID: 38864783, PMCID: PMC11343654, DOI: 10.1016/j.annemergmed.2024.04.023.Peer-Reviewed Original ResearchOut-of-pocketED visitsTraditional MedicareOlder adultsEmergency departmentMedicare AdvantageMedicare Advantage plan enrolleesMedicare Current Beneficiary SurveyEmergency department careTreat-and-releaseOut-of-pocket expensesOut-of-pocket health care spendingHealth care spendingCross-sectional analysisProportion of costsMedian totalEmergency careTreat-and-release emergency departmentBeneficiary SurveyMedian total costProportion of expensesCare spendingPlan enrolleesMedicareVisitsGeriatric Emergency Departments
Hwang U, Dresden S, Southerland L, Meldon S. Geriatric Emergency Departments. 2024, 231-237. DOI: 10.1007/978-3-031-56204-4_24.Peer-Reviewed Original ResearchImpact of the geriatric emergency medicine specialist intervention on final emergency department disposition
Cohen I, Sangal R, Taylor R, Crawford A, Lai J, Martin P, Palleschi S, Rothenberg C, Tomasino D, Hwang U. Impact of the geriatric emergency medicine specialist intervention on final emergency department disposition. Journal Of The American Geriatrics Society 2024, 72: 2017-2026. PMID: 38667266, DOI: 10.1111/jgs.18908.Peer-Reviewed Original ResearchED length of stayED lengthLength of stayObservation admissionsED dispositionInpatient admissionsEmergency departmentOdds of inpatient admissionRate of hospital admissionsAdvanced practice providersGeriatric ED patientsEmergency medicine specialistsTarget trial emulation frameworkHospital admission ratesOdds of dischargeRegional healthcare systemEmergency department dispositionIncreased odds of dischargeCare planningPractice providersED sitesED visitsOlder adultsSpecialist interventionAdmission ratesGeriatric Emergency Medication Safety Recommendations (GEMS-Rx): Modified Delphi Development of a High-Risk Prescription List for Older Emergency Department Patients
Skains R, Koehl J, Aldeen A, Carpenter C, Gettel C, Goldberg E, Hwang U, Kocher K, Southerland L, Goyal P, Berdahl C, Venkatesh A, Lin M. Geriatric Emergency Medication Safety Recommendations (GEMS-Rx): Modified Delphi Development of a High-Risk Prescription List for Older Emergency Department Patients. Annals Of Emergency Medicine 2024, 84: 274-284. PMID: 38483427, PMCID: PMC11343681, DOI: 10.1016/j.annemergmed.2024.01.033.Peer-Reviewed Original ResearchOlder ED patientsHigh-risk prescriptionsED patientsHigh-risk medication usePrescribed high-risk medicationsEmergency departmentHigh-risk medicationsEnd of lifeShort-term adverse eventsAdverse drug eventsQuestionnaire response rateEmergency department patientsDrug eventsRound 2Prescription refillsPhysician expertsMedication useSkeletal muscle relaxantsDepartment patientsMedication categoriesAdverse eventsRisk of short-term adverse eventsMedication classesMedical indicationsPrescription listScaling the EQUIPPED medication safety program: Traditional and hub‐and‐spoke implementation models
Vandenberg A, Hwang U, Das S, Genes N, Nyamu S, Richardson L, Ezenkwele U, Legome E, Richardson C, Belachew A, Leong T, Kegler M, Vaughan C. Scaling the EQUIPPED medication safety program: Traditional and hub‐and‐spoke implementation models. Journal Of The American Geriatrics Society 2024, 72: 2184-2194. PMID: 38259070, DOI: 10.1111/jgs.18746.Peer-Reviewed Original ResearchPotentially inappropriate medicationsHub-and-spoke modelEmergency departmentSpoke sitesReduce potentially inappropriate medicationMedication safety programQuality improvement initiativesElectronic medical recordsInappropriate medicationsHealth systemImprovement initiativesPrescribing dataHub-and-spokeDisproportionate barriersImplementation modelMedical recordsSite engagementInterview dataSafety programCOVID-19 pandemicProgramEQUIP programCOVID-19BarriersHealth
2023
Development of the COMET tool: Caregiver‐reported Outcome Measure for Emergency care Transitions
Gettel C, Galske J, Uzamere I, Serina P, Hernandez‐Bigos K, Mane S, Chen K, Ottilie‐Kovelman S, Sandoval J, Venkatesh A, Cohen A, Monin J, Fried T, Hwang U. Development of the COMET tool: Caregiver‐reported Outcome Measure for Emergency care Transitions. Alzheimer's & Dementia 2023, 19 DOI: 10.1002/alz.074213.Peer-Reviewed Original ResearchCare transitionsOutcome measuresCare partnersED discharge processPhase 3Results Phase 1Phase 2Health care systemPhase 1Candidate itemsAcute illnessED encountersEmergency departmentCare considerationsPhase 4Outcome assessmentConclusion DevelopmentScreening toolCare systemResearch team membersContent validityPoor communicationEDMultidisciplinary stakeholdersDelphi approachPatterns of emergency department visits prior to dementia or cognitive impairment diagnosis: An opportunity for dementia detection?
Seidenfeld J, Runels T, Goulet J, Augustine M, Brandt C, Hastings S, Hung W, Ragsdale L, Sullivan J, Zhu C, Hwang U. Patterns of emergency department visits prior to dementia or cognitive impairment diagnosis: An opportunity for dementia detection? Academic Emergency Medicine 2023 PMID: 37935451, PMCID: PMC11074234, DOI: 10.1111/acem.14832.Peer-Reviewed Original ResearchAutomating risk stratification for geriatric syndromes in the emergency department
Haimovich A, Shah M, Southerland L, Hwang U, Patterson B. Automating risk stratification for geriatric syndromes in the emergency department. Journal Of The American Geriatrics Society 2023, 72: 258-267. PMID: 37811698, PMCID: PMC10866303, DOI: 10.1111/jgs.18594.Peer-Reviewed Original ResearchRisk stratificationGeriatric syndromesCognitive impairmentGeriatric Emergency Department GuidelinesHigh-risk patientsRisk stratification approachHigh-risk populationED patient volumeEmergency Department GuidelinesGeriatric emergency careElectronic health recordsOlder patientsRisk patientsPalliative careEmergency departmentProvider burdenImproved careLife careEmergency carePatient volumeDepartment guidelinesOlder adultsHealth recordsCareEHR dataAn Outcome Comparison Between Geriatric and Nongeriatric Emergency Departments
Gettel C, Hwang U, Janke A, Rothenberg C, Tomasino D, Schneider S, Goyal P, Venkatesh A. An Outcome Comparison Between Geriatric and Nongeriatric Emergency Departments. Annals Of Emergency Medicine 2023, 82: 681-689. PMID: 37389490, PMCID: PMC10756927, DOI: 10.1016/j.annemergmed.2023.05.013.Peer-Reviewed Original ResearchConceptsGeriatric EDDiagnosis rateED lengthEmergency departmentMedian discharge rateAmerican CollegeRevisit ratesOlder adultsUrinary tract infectionAge categoriesGeriatric Emergency DepartmentHigher diagnosis ratesED visitsTract infectionsMental statusObservational studyDelirium/Outcome comparisonsData registryED statusProcess outcomesED sitesStayAnalytic sampleAdultsDissemination and implementation of age‐friendly care and geriatric emergency department accreditation at Veterans Affairs hospitals
Hwang U, Runels T, Han L, Gruber E, McQuown C, Ragsdale L, Jetter E, Rossomano N, Javier D. Dissemination and implementation of age‐friendly care and geriatric emergency department accreditation at Veterans Affairs hospitals. Academic Emergency Medicine 2023, 30: 270-277. PMID: 36653961, DOI: 10.1111/acem.14665.Peer-Reviewed Original ResearchConceptsVA emergency departmentEmergency departmentOlder veteransED visitsVA Corporate Data WarehouseAge-friendly careIndex ED visitVeterans Affairs hospitalYears of ageCorporate Data WarehouseScreening prevalencePoor outcomeStandardization of practiceMean ageVisit encountersPotential confoundingEmergency careGreater oddsExtended careDemographic dataOlder adultsLevel 1Observational evaluationCarePandemic year
2022
Identifying and Prioritizing Research to Improve Emergency Care of Persons Living With Dementia: A Geriatric Emergency care Applied Research 2.0 Network ‐ Advancing Dementia Care (GEAR 2.0‐ADC) Scoping Review
Gifford A, Shah M, Carpenter C, Dresden S, Dussetschleger J, Leggett J, Taylor Z, Hwang U. Identifying and Prioritizing Research to Improve Emergency Care of Persons Living With Dementia: A Geriatric Emergency care Applied Research 2.0 Network ‐ Advancing Dementia Care (GEAR 2.0‐ADC) Scoping Review. Alzheimer's & Dementia 2022, 18 DOI: 10.1002/alz.061593.Peer-Reviewed Original ResearchEmergency departmentCare partnersEmergency careTask force membersPatient-centered care interventionsLiterature searchUnique care needsSystematic literature searchMeasurement of dementiaScoping ReviewPRISMA-ScR guidelinesTask ForceED settingPICO questionCare interventionsCare needsConsensus conferenceClinical practiceOutcome questionsDementia careBackground PersonsMedical staffDementiaCareDementia detectionUse of the consolidated framework for implementation research in a mixed methods evaluation of the EQUIPPED medication safety program in four academic health system emergency departments
Kegler M, Rana S, Vandenberg A, Hastings S, Hwang U, Eucker S, Vaughan C. Use of the consolidated framework for implementation research in a mixed methods evaluation of the EQUIPPED medication safety program in four academic health system emergency departments. Frontiers In Health Services 2022, 2: 1053489. PMID: 36925898, PMCID: PMC10012623, DOI: 10.3389/frhs.2022.1053489.Peer-Reviewed Original ResearchEmergency departmentConsolidated FrameworkVeterans Administration health care systemPrimary implementation outcomeImplementation researchMedication safety programAcademic health systemImplementation outcomesQuality Improvement ProgramFidelity of deliveryHealth care systemEvidence-based approachProviders' receiptInappropriate medicationsMixed-methods evaluationEvidence-informed programsED providersED settingPrescribing practicesAcademic detailingMedication safetyPatient needsEffective quality improvement programOrder setsHealth system74EMF Early Phase Development of the PROM-OTED Tool: The Patient-Reported Outcome Measure – Older Adult Care Transitions from the Emergency Department
Gettel C, Serina P, Uzamere I, Hernandez-Bigos K, Venkatesh A, Feder S, Goldberg E, White M, Rising K, Hwang U. 74EMF Early Phase Development of the PROM-OTED Tool: The Patient-Reported Outcome Measure – Older Adult Care Transitions from the Emergency Department. Annals Of Emergency Medicine 2022, 80: s38-s39. DOI: 10.1016/j.annemergmed.2022.08.097.Peer-Reviewed Original ResearchOptimal Emergency Department Care Practices for Persons Living With Dementia: A Scoping Review
Dresden SM, Taylor Z, Serina P, Kennedy M, Wescott AB, Hogan T, Shah MN, Hwang U, Aggarawal N, Allore H, Aloysi A, Belleville M, Bellolio F, Betz M, Biese K, Brandt C, Bruursema S, Carnahan R, Carpenter C, Carr D, Chin-Hansen J, Daven M, Degesys N, Dresden S, Dussetschleger J, Ellenbogen M, Falvey J, Foster B, Gettel C, Gifford A, Gilmore-Bykovskyi A, Goldberg E, Han J, Hardy J, Hastings S, Hirshon J, Hoang L, Hogan T, Hung W, Hwang U, Isaacs E, Jaspal N, Jobe D, Johnson J, Kelly K, Kennedy M, Kind A, Leggett J, Malone M, Moccia M, Moreno M, Morrow-Howell N, Nowroozpoor A, Ohuabunwa U, Oiyemhonian B, Perry W, Prusaczyk B, Resendez J, Rising K, Sano M, Savage B, Shah M, Suyama J, Swartzberg J, Taylor Z, Tolia V, Vann A, Webb T, Weintraub S. Optimal Emergency Department Care Practices for Persons Living With Dementia: A Scoping Review. Journal Of The American Medical Directors Association 2022, 23: 1314.e1-1314.e29. PMID: 35940683, DOI: 10.1016/j.jamda.2022.05.024.Peer-Reviewed Original ResearchConceptsED careCare practicesCare needsHealth care use outcomesEmergency care needsComprehensive geriatric assessmentManagement of painEmergency department carePatient-centered outcomesED care processesHome hospital programScoping ReviewSingle-site studyResearch prioritiesPRISMA-ScR guidelinesGeriatric assessmentSystematic scoping reviewDementia care networksEmergency departmentCare considerationsCare competenciesHospital programED environmentCare processesPsychological symptomsEmergency department‐to‐community care transition barriers: A qualitative study of older adults
Gettel CJ, Serina PT, Uzamere I, Hernandez‐Bigos K, Venkatesh AK, Rising KL, Goldberg EM, Feder SL, Cohen AB, Hwang U. Emergency department‐to‐community care transition barriers: A qualitative study of older adults. Journal Of The American Geriatrics Society 2022, 70: 3152-3162. PMID: 35779278, PMCID: PMC9669106, DOI: 10.1111/jgs.17950.Peer-Reviewed Original ResearchConceptsCare transitionsOlder adultsClinical careImmediate post-discharge periodED discharge processEmergency clinical careEmergency department visitsPost-discharge periodAdverse health outcomesOutpatient clinical careDepartment visitsIntact patientsEmergency departmentHealth outcomesOlder adults' willingnessU.S. healthcare systemBaseline activityEffective interventionsIntervention developmentHealthcare systemAdultsCareAdults' willingnessSymptom explanationsED