Featured Publications
Association of a Geriatric Emergency Department Innovation Program With Cost Outcomes Among Medicare Beneficiaries
Hwang U, Dresden SM, Vargas-Torres C, Kang R, Garrido MM, Loo G, Sze J, Cruz D, Richardson LD, Adams J, Aldeen A, Baumlin KM, Courtney DM, Gravenor S, Grudzen CR, Nimo G, Zhu CW, Abraham G, Amoko C, Genes N, Morano B, Nassisi D, Ortiz J, Rivera-Reyes L, Sanon M, Shapiro J, Winkel G, Malik S, Rosenberg M, Christensen M, Karounos M, Schultz R, Sumberg D. Association of a Geriatric Emergency Department Innovation Program With Cost Outcomes Among Medicare Beneficiaries. JAMA Network Open 2021, 4: e2037334. PMID: 33646311, PMCID: PMC7921898, DOI: 10.1001/jamanetworkopen.2020.37334.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCost SavingsCross-Sectional StudiesEmergency Medical ServicesEmergency Service, HospitalFee-for-Service PlansGeriatric AssessmentHealth Services for the AgedHospital CostsHospitalsHumansMedicarePatient CareReferral and ConsultationSocial WorkTransitional CareUnited StatesConceptsTransitional care nursesFirst ED visitIndex ED visitED visitsMAIN OUTCOMEMedicare feeMedicare beneficiariesService beneficiariesEmergency department programComparison groupCross-sectional studyUnique Medicare beneficiariesLower Medicare expendituresMost patientsMean ageCare nursesVisit encountersCare programGeriatric treatmentCost outcomesPatient careMedicare expendituresHealth systemMean savingsPatients
2024
End‐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 enrolleesMedicareVisitsImpact 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 ratesPatient‐reported outcome measure use among older adults after emergency department care: A systematic review
Gettel C, Galske J, Sather A, Haidous A, Hwang U, Brackett A, Venkatesh A, Rising K, Goldberg E, van Oppen J, Conroy S, Carpenter C. Patient‐reported outcome measure use among older adults after emergency department care: A systematic review. Academic Emergency Medicine 2024, 31: 273-287. PMID: 38366698, DOI: 10.1111/acem.14850.Peer-Reviewed Original ResearchPatient-reported outcome measuresActivities of daily livingED visitsOlder adultsPhysical functionPatient-reported outcome measure useInstrumental activities of daily livingKatz activities of daily livingOlder adult ED patientsPatient-reported outcome measure assessmentSystematic reviewOutcome measure useEmergency department carePatient symptom burdenFull-text screeningAdult ED patientsRisk of biasQuality of lifeStudy inclusion criteriaWeb of Science-Core CollectionKatz ActivitiesEmergency careDaily livingPROM assessmentBarthel Index
2023
An 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
2021
Evaluation and disposition of older adults presenting to the emergency department with abdominal pain
Friedman AB, Chen AT, Wu R, Coe NB, Halpern SD, Hwang U, Kelz RR, Cappola AR. Evaluation and disposition of older adults presenting to the emergency department with abdominal pain. Journal Of The American Geriatrics Society 2021, 70: 501-511. PMID: 34628638, PMCID: PMC10078825, DOI: 10.1111/jgs.17503.Peer-Reviewed Original ResearchConceptsNational Hospital Ambulatory Medical Care SurveyAbdominal painUS emergency departmentsEmergency departmentED visitsOlder adultsOlder patientsChief complaintAmbulatory Medical Care SurveyRepresentative emergency departmentsCommon chief complaintSurvey-weighted analysisDischarge homeIncident disabilityED encountersCare SurveyPatient outcomesCritical careSerious conditionSyndromic presentationHigh riskPainDiagnostic testingPatientsCT imagingEmergency department visits for emergent conditions among older adults during the COVID‐19 pandemic
Janke AT, Jain S, Hwang U, Rosenberg M, Biese K, Schneider S, Goyal P, Venkatesh AK. Emergency department visits for emergent conditions among older adults during the COVID‐19 pandemic. Journal Of The American Geriatrics Society 2021, 69: 1713-1721. PMID: 33955546, PMCID: PMC8242842, DOI: 10.1111/jgs.17227.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionED visit countsOlder adultsHip fractureExcess mortalityEmergent conditionsED sitesVisit countsEmergency department visitsIncident rate ratiosNational clinical quality registryAge categoriesClinical quality registryEarly pandemic periodCOVID-19 pandemicPandemic periodPoisson regression modelsPre-pandemic periodED visitsYounger patientsDepartment visitsPoor outcomeEmergency departmentMyocardial infarctionED diagnosis
2019
Geriatric Emergency Department Innovations: The Impact of Transitional Care Nurses on 30‐day Readmissions for Older Adults
Dresden SM, Hwang U, Garrido MM, Sze J, Kang R, Vargas‐Torres C, Courtney DM, Loo G, Rosenberg M, Richardson L. Geriatric Emergency Department Innovations: The Impact of Transitional Care Nurses on 30‐day Readmissions for Older Adults. Academic Emergency Medicine 2019, 27: 43-53. PMID: 31663245, DOI: 10.1111/acem.13880.Peer-Reviewed Original ResearchConceptsIndex ED visitMount Sinai Medical CenterSt. Joseph's Regional Medical CenterNorthwestern Memorial HospitalPrior hospital dischargeEmergency departmentED visitsRegional Medical CenterOlder adultsHospital dischargeGeriatric patientsNurse careMedical CenterTransitional care nursesRisk of admissionEmergency Severity IndexSinai Medical CenterDecreased hospitalizationsDecreased readmissionsPrior hospitalizationProspective cohortED patientsCare nursesMemorial HospitalInpatient discharges30‐Day Emergency Department Revisit Rates among Older Adults with Documented Dementia
Kent T, Lesser A, Israni J, Hwang U, Carpenter C, Ko KJ. 30‐Day Emergency Department Revisit Rates among Older Adults with Documented Dementia. Journal Of The American Geriatrics Society 2019, 67: 2254-2259. PMID: 31403717, PMCID: PMC6899685, DOI: 10.1111/jgs.16114.Peer-Reviewed Original ResearchConceptsIndex ED visitED revisitsEmergency departmentED visitsDementia diagnosisIndex encounterOdds ratioOlder adultsMedicare beneficiariesEmergency department revisit rateRevisit ratesED revisit ratesHigh ED utilizationSignificant predictorsNational emergency departmentSkilled nursing facilitiesLogistic regression modelsDementia codesED utilizationMedicaid statusOutpatient claimsRepresentative sampleContinuous feeClaims dataDementia patients
2018
Geriatric Emergency Department Innovations: Transitional Care Nurses and Hospital Use
Hwang U, Dresden SM, Rosenberg MS, Garrido MM, Loo G, Sze J, Gravenor S, Courtney DM, Kang R, Zhu CW, Vargas‐Torres C, Grudzen CR, Richardson LD, Investigators T. Geriatric Emergency Department Innovations: Transitional Care Nurses and Hospital Use. Journal Of The American Geriatrics Society 2018, 66: 459-466. PMID: 29318583, PMCID: PMC6764445, DOI: 10.1111/jgs.15235.Peer-Reviewed Original ResearchConceptsTransitional care nursesIndex ED visitED revisitsED visitsCare nursesInpatient admissionsHospital useProspective observational cohortU.S. EDsClinical characteristicsObservational cohortSecondary outcomesPrimary outcomeEmergency departmentObserved selection biasLower riskAdmissionCare staffGreater riskStudy periodRiskOutcomesSelection biasNursesVisits
2017
Bouncing Back Elsewhere: Multilevel Analysis of Return Visits to the Same or a Different Hospital After Initial Emergency Department Presentation
Shy BD, Loo GT, Lowry T, Kim EY, Hwang U, Richardson LD, Shapiro JS. Bouncing Back Elsewhere: Multilevel Analysis of Return Visits to the Same or a Different Hospital After Initial Emergency Department Presentation. Annals Of Emergency Medicine 2017, 71: 555-563.e1. PMID: 28967514, DOI: 10.1016/j.annemergmed.2017.08.023.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overChildChild, PreschoolEmergency Service, HospitalFemaleHealth Information ExchangeHumansInfantInfant, NewbornMaleMiddle AgedMultilevel AnalysisOdds RatioPatient ReadmissionQuality Assurance, Health CareQuality ImprovementRetrospective StudiesTime FactorsYoung AdultConceptsED visitsSame hospitalReturn visitsOdds ratioHealth information exchangeInitial emergency department presentationEmergency department return visitsInitial ED visitED return visitsInitial ED presentationEmergency department presentationsConfidence intervalsHospital-level dataEarly revisitsED presentationsInitial visitMale sexSecond HospitalStudy EDPatient visitsAcademic hospitalHospital variablesHealth information exchange networkDifferent hospitalsHospital
2016
Preparing Older Adults with Serious Illness To Formulate Their Goals for Medical Care in the Emergency Department
Ouchi K, Knabben V, Rivera-Reyes L, Ganta N, Gelfman LP, Sudore R, Hwang U, on behalf of the GEDI WISE Investig. Preparing Older Adults with Serious Illness To Formulate Their Goals for Medical Care in the Emergency Department. Journal Of Palliative Medicine 2016, 20: 404-408. PMID: 27797638, PMCID: PMC5385414, DOI: 10.1089/jpm.2016.0109.Peer-Reviewed Original ResearchOlder ED patientsED patientsOlder adultsEmergency department cliniciansAdvance care planning conversationsPercent of participantsED visitsSecondary outcomesPrimary outcomeED careEmergency departmentMean ageInclusion criteriaACP educationSerious illnessHealth educationED surveyMedical careYears ageParent cohortED implementationVision impairmentPlanning conversationsFurther studiesPatientsIncreased Identification of Emergency Department 72‐hour Returns Using Multihospital Health Information Exchange
Shy BD, Kim EY, Genes NG, Lowry T, Loo GT, Hwang U, Richardson LD, Shapiro JS. Increased Identification of Emergency Department 72‐hour Returns Using Multihospital Health Information Exchange. Academic Emergency Medicine 2016, 23: 645-649. PMID: 26932394, DOI: 10.1111/acem.12954.Peer-Reviewed Original ResearchConceptsEmergency departmentHealth information exchangeED returnIndex visitReturn visitsEarly ED returnsInitial ED dischargeCases of patientsReturn visit rateLarge health information exchangeIndividual emergency departmentsPatient safety effortsED dischargeED visitsEarly returnVisit ratesPatient encountersStudy periodPatient dataVisitsNew York metropolitan areaSafety effortsDepartmentHoursPatients
2015
A Multicenter Evaluation of the Impact of Sex on Abdominal and Fracture Pain Care
Siddiqui A, Belland L, Rivera-Reyes L, Handel D, Yadav K, Heard K, Eisenberg A, Hwang U. A Multicenter Evaluation of the Impact of Sex on Abdominal and Fracture Pain Care. Medical Care 2015, 53: 948-953. PMID: 26465122, PMCID: PMC4610254, DOI: 10.1097/mlr.0000000000000430.Peer-Reviewed Original ResearchConceptsAbdominal painAnalgesic administrationPain careMulticenter evaluationFinal ED diagnosisInitial pain scoreSingle pain conditionRetrospective cohort reviewType of painSex-based disparitiesImpact of sexPain scoresCohort reviewED visitsSecondary outcomesPain conditionsPrimary outcomeMulticenter studyTriage acuityED diagnosisMultivariable modelMedication ordersSex disparitiesCare outcomesED crowding
2013
Transforming Emergency Care For Older Adults
Hwang U, Shah MN, Han JH, Carpenter CR, Siu AL, Adams JG. Transforming Emergency Care For Older Adults. Health Affairs 2013, 32: 2116-2121. PMID: 24301394, PMCID: PMC4070367, DOI: 10.1377/hlthaff.2013.0670.Peer-Reviewed Original ResearchConceptsEmergency departmentEmergency careHealth care systemOlder adultsCare systemComprehensive discharge planningUS emergency departmentsPatient health outcomesGeriatric emergency careGeriatric Emergency DepartmentBroader health care systemED visitsInitial hospitalizationDischarge planningCare coordinationHealth outcomesObservation unitCareAdultsLengthy evaluationRehospitalizationHospitalizationPatientsVisits
2011
Characteristics of Frequent Geriatric Users of an Urban Emergency Department
Wajnberg A, Hwang U, Torres L, Yang S. Characteristics of Frequent Geriatric Users of an Urban Emergency Department. Journal Of Emergency Medicine 2011, 43: 376-381. PMID: 22040771, DOI: 10.1016/j.jemermed.2011.06.056.Peer-Reviewed Original ResearchMeSH KeywordsAbdominal PainAgedAged, 80 and overBlack or African AmericanChest PainChi-Square DistributionConfidence IntervalsEmergency Service, HospitalFemaleHealth Care SurveysHealth Services AccessibilityHispanic or LatinoHumansMaleOdds RatioPatient AcuityPrimary Health CareProspective StudiesRetrospective StudiesTriageUrban Health ServicesConceptsEmergency department utilizationYears of ageED usersED visitsOlder adultsFrequent Emergency Department UtilizationGeriatric usersProspective telephone surveyFrequent ED usersRetrospective chart reviewHealth-related qualityPrimary care providersUrban emergency departmentChart reviewED utilizationOlder patientsUrban EDUnique patientsEmergency departmentPrimary careOutpatient providersCare providersUsual sourceED crowdingUnivariate descriptive statisticsVariations in Crowding and Ambulance Diversion in Nine Emergency Departments
Handel DA, Pines J, Aronsky D, Genes N, Ginde AA, Hackman J, Hilton JA, Hwang U, Kamali M, Powell E, Sattarian M, Fu R. Variations in Crowding and Ambulance Diversion in Nine Emergency Departments. Academic Emergency Medicine 2011, 18: 941-946. PMID: 21906203, DOI: 10.1111/j.1553-2712.2011.01149.x.Peer-Reviewed Original ResearchConceptsEmergency departmentED bedsAmbulance diversionED visitsOverall mean LOSAnnual ED censusPrimary outcome variablePrimary study aimPrimary predictor variableDaily ED visitsPercentage of daysMean LOSAcute treatmentMulticenter studyED censusSurrogate markerED crowdingStudy aimMean differenceOutcome variablesDichotomous variablesTotal numberVisitsDaysDiversion