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
2023
Geriatric assessment in the emergency department reduces healthcare costs—So when will CMS pay for it?
Southerland L, Biese K, Hwang U. Geriatric assessment in the emergency department reduces healthcare costs—So when will CMS pay for it? Journal Of The American Geriatrics Society 2023, 71: 2698-2700. PMID: 37435831, DOI: 10.1111/jgs.18473.Peer-Reviewed Original ResearchResearch and policy recommendations from the SOTA XVI: State of the Art Conference on VA Emergency Medicine
Ward M, Hwang U, Hastings S, Timko C, Chen J, Vashi A, Mattocks K, Abel E, Bravata D. Research and policy recommendations from the SOTA XVI: State of the Art Conference on VA Emergency Medicine. Academic Emergency Medicine 2023, 30: 240-251. PMID: 36775279, PMCID: PMC11166248, DOI: 10.1111/acem.14679.Peer-Reviewed Original ResearchConceptsMental health needsEmergency careOlder veteransHealth needsEmergency Department Care TransitionsCommunity settingsVeterans Affairs Health Services ResearchFollow-up needsGeriatric assessment toolsEmergency medicineCommunity care settingsCare Improvement (BPCI) initiativeNon-VA sourcesSuicide prevention interventionsSubstance use disordersUse of telehealthHealth services researchEvaluation of interventionsEmergency cliniciansCare transitionsCare coordinationPatient outcomesArt ConferenceCare settingsPrevention interventionsDissemination 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 ResearchMeSH KeywordsAgedAged, 80 and overEmergency Service, HospitalFemaleHospitalsHumansMaleUnited StatesVeteransConceptsVA 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
Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme
Vaughan CP, Hwang U, Vandenberg AE, Leong T, Wu D, Stevens MB, Clevenger C, Eucker S, Genes N, Huang W, Ikpe-Ekpo E, Nassisi D, Previl L, Rodriguez S, Sanon M, Schlientz D, Vigliotti D, Hastings SN. Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme. BMJ Open Quality 2021, 10: e001369. PMID: 34750188, PMCID: PMC8576471, DOI: 10.1136/bmjoq-2021-001369.Peer-Reviewed Original ResearchConceptsVeterans Health AdministrationAcademic health systemElectronic medical recordsHealth systemMedical recordsPrescribing outcomesOlder adultsVA health systemMedication safety programMonthly proportionEpic electronic medical recordDifferent health systemsSignificant reductionBeers criteriaMonthly prescribingMonths preimplementationInappropriate medicationsBenzodiazepine prescriptionsPrescribing ratesEmergency departmentMonths postimplementationDrug classesHealth AdministrationOrder setsVA systemEvaluation 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 imagingInclusion of older adults in emergency department clinical research: Strategies to achieve a critical goal
Hunold KM, Goldberg EM, Caterino JM, Hwang U, Platts‐Mills T, Shah MN, Rosen T, Medicine F. Inclusion of older adults in emergency department clinical research: Strategies to achieve a critical goal. Academic Emergency Medicine 2021, 29: 376-383. PMID: 34582613, PMCID: PMC8958170, DOI: 10.1111/acem.14386.Peer-Reviewed Original ResearchReach and Adoption of a Geriatric Emergency Department Accreditation Program in the United States
Kennedy M, Lesser A, Israni J, Liu SW, Santangelo I, Tidwell N, Southerland LT, Carpenter CR, Biese K, Ahmad S, Hwang U. Reach and Adoption of a Geriatric Emergency Department Accreditation Program in the United States. Annals Of Emergency Medicine 2021, 79: 367-373. PMID: 34389196, PMCID: PMC10015385, DOI: 10.1016/j.annemergmed.2021.06.013.Peer-Reviewed Original ResearchMeSH KeywordsAccreditationAgedCohort StudiesEmergency Service, HospitalHumansRural PopulationUnited StatesConceptsGeriatric Emergency DepartmentEmergency departmentCare processesUrinary catheter useUS emergency departmentsHealth care utilizationPatient-oriented outcomesAccreditation programCatheter useCare utilizationEmergency physiciansAmerican CollegeRural designationStudy periodInterquartile rangeSignificant heterogeneityPotential needContinuous dataLow levelsLevel 1Level 2CohortPhysiciansPreventionEmergency 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 diagnosisGeriatric emergency department revisits after discharge with Potentially Inappropriate Medications: A retrospective cohort study
Hammouda N, Vargas-Torres C, Doucette J, Hwang U. Geriatric emergency department revisits after discharge with Potentially Inappropriate Medications: A retrospective cohort study. The American Journal Of Emergency Medicine 2021, 44: 148-156. PMID: 33621716, DOI: 10.1016/j.ajem.2021.02.004.Peer-Reviewed Original ResearchConceptsCharlson Comorbidity Index scoreComorbidity Index scoreED revisitsEmergency Severity Index scoreEmergency departmentAcademic emergency departmentInappropriate medicationsHospital admissionChief complaintIndex scoreBeers criteriaMedicaid statusRisk factorsMedicare beneficiaries 65 yearsDay ED visitsUpdated Beers CriteriaRetrospective cohort studyEmergency department revisitsRetrospective chart reviewSeverity Index scoreBeneficiaries 65 yearsCovariate risk factorsMedicare beneficiaries 65Multiple logistic regressionEmergency Severity Index
2020
AGS Position Statement: Resource Allocation Strategies and Age‐Related Considerations in the COVID‐19 Era and Beyond
Farrell TW, Ferrante LE, Brown T, Francis L, Widera E, Rhodes R, Rosen T, Hwang U, Witt LJ, Thothala N, Liu SW, Vitale CA, Braun UK, Stephens C, Saliba D. AGS Position Statement: Resource Allocation Strategies and Age‐Related Considerations in the COVID‐19 Era and Beyond. Journal Of The American Geriatrics Society 2020, 68: 1136-1142. PMID: 32374440, PMCID: PMC7267615, DOI: 10.1111/jgs.16537.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsAmerican Geriatrics SocietyOlder adultsAppropriate advance care planningShort-term outcomesRelevant clinical factorsCoronavirus disease 2019Advance care planningPotential short-term outcomeClinical factorsSevere illnessAdvanced ageDisease 2019Care planningMortality riskGeriatrics SocietySocial determinantsHealthcare professionalsHealth systemOlder peopleInterprofessional expertsEthics CommitteeCOVID-19 eraLife expectancyAgeCOVID-19Rationing Limited Healthcare Resources in the COVID‐19 Era and Beyond: Ethical Considerations Regarding Older Adults
Farrell TW, Francis L, Brown T, Ferrante LE, Widera E, Rhodes R, Rosen T, Hwang U, Witt LJ, Thothala N, Liu SW, Vitale CA, Braun UK, Stephens C, Saliba D. Rationing Limited Healthcare Resources in the COVID‐19 Era and Beyond: Ethical Considerations Regarding Older Adults. Journal Of The American Geriatrics Society 2020, 68: 1143-1149. PMID: 32374466, PMCID: PMC7267288, DOI: 10.1111/jgs.16539.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus Statements
2019
30‐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
2017
An Interdisciplinary Academic Detailing Approach to Decrease Inappropriate Medication Prescribing by Physician Residents for Older Veterans Treated in the Emergency Department
Moss JM, Bryan WE, Wilkerson LM, King HA, Jackson GL, Owenby RK, Van Houtven CH, Stevens MB, Powers J, Vaughan CP, Hung WW, Hwang U, Markland AD, Sloane R, Knaack W, Hastings SN. An Interdisciplinary Academic Detailing Approach to Decrease Inappropriate Medication Prescribing by Physician Residents for Older Veterans Treated in the Emergency Department. Journal Of Pharmacy Practice 2017, 32: 167-174. PMID: 29277130, PMCID: PMC6533068, DOI: 10.1177/0897190017747424.Peer-Reviewed Original ResearchMeSH KeywordsAgedClinical CompetenceDrug PrescriptionsEducation, MedicalEmergency MedicineEmergency Service, HospitalHealth Services for the AgedHumansInappropriate PrescribingInternship and ResidencyInterprofessional RelationsPhysiciansPotentially Inappropriate Medication ListQuality ImprovementSurveys and QuestionnairesUnited StatesUnited States Department of Veterans AffairsVeteransConceptsQuality improvement projectAcademic detailingEmergency departmentOlder adultsPIM ratesBeers criteriaPhysician residentsResident cohortVeterans Affairs emergency departmentInappropriate medication prescribingAcademic detailing interventionDrug-disease interactionsImprovement projectSelf-perceived barriersInappropriate medicationsMedication prescribingED populationAppropriate medicationOlder veteransSelf-reported confidenceCohortEducational interventionRate ratioSignificant decreaseSelf-rated confidence
2016
A Multicenter Evaluation of Emergency Department Pain Care Across Different Types of Fractures
Siddiqui A, Belland L, Rivera-Reyes L, Handel D, Yadav K, Heard K, Eisenberg A, Khelemsky Y, Hwang U. A Multicenter Evaluation of Emergency Department Pain Care Across Different Types of Fractures. Pain Medicine 2016, 18: 41-48. PMID: 27245631, PMCID: PMC5283699, DOI: 10.1093/pm/pnw072.Peer-Reviewed Original ResearchConceptsPain careEmergency departmentType of fractureFracture typeOlder patientsBaseline pain scoresRetrospective cohort studyLong bone fracturesOpioid doseAnalgesic administrationAnalgesic usePain scoresCohort studyTriage acuityFinal diagnosisSubgroup analysisMulticenter evaluationED crowdingPatientsBone fracturesSecondary analysisAge-based differencesCareProcess outcomesGreater likelihoodThe musculoskeletal diagnosis cohort
Goulet JL, Kerns RD, Bair M, Becker W, Brennan P, Burgess DJ, Carroll CM, Dobscha S, Driscoll M, Fenton BT, Fraenkel L, Haskell S, Heapy A, Higgins D, Hoff RA, Hwang U, Justice AC, Piette JD, Sinnott P, Wandner L, Womack J, Brandt CA. The musculoskeletal diagnosis cohort. Pain 2016, 157: 1696-1703. PMID: 27023420, PMCID: PMC4949131, DOI: 10.1097/j.pain.0000000000000567.Peer-Reviewed Original ResearchConceptsMSD diagnosisMusculoskeletal disordersMSD cohortIndex dateVeterans Health Administration (VHA) careNumeric rating scale scoreICD-9-CM codesCohort inclusion criteriaNontraumatic joint disordersPain-related treatmentsMore outpatient visitsVeterans Health AdministrationMental health diagnosesRating Scale scoresHigher NRS scoresHealth services researchElectronic health recordsDiagnosis cohortSevere painInpatient visitsNRS scoresOutpatient visitsNeck disordersFirst diagnosisMean age
2015
Redesigned Geriatric Emergency Care May Have Helped Reduce Admissions Of Older Adults To Intensive Care Units
Grudzen C, Richardson LD, Baumlin KM, Winkel G, Davila C, Ng K, Hwang U, investigators T. Redesigned Geriatric Emergency Care May Have Helped Reduce Admissions Of Older Adults To Intensive Care Units. Health Affairs 2015, 34: 788-795. PMID: 25941280, DOI: 10.1377/hlthaff.2014.0790.Peer-Reviewed Original ResearchConceptsGeriatric emergency careMount Sinai Medical CenterPalliative care principlesIntensive care unitEmergency careCare unitEmergency departmentCare principlesHigh-risk patientsED triage nursesSinai Medical CenterWise programED nurse practitionersED visitorsED revisitsED admissionHospital readmissionMedical CenterNurse practitionersTriage nursesHigh riskHospice careAdmissionOlder adultsStudy period
2014
Optimal Older Adult Emergency Care: Introducing Multidisciplinary Geriatric Emergency Department Guidelines From the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine
Carpenter CR, Bromley M, Caterino JM, Chun A, Gerson LW, Greenspan J, Hwang U, John DP, Lyons WL, Platts‐Mills T, Mortensen B, Ragsdale L, Rosenberg M, Wilber S. Optimal Older Adult Emergency Care: Introducing Multidisciplinary Geriatric Emergency Department Guidelines From the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine. Academic Emergency Medicine 2014, 21: 806-809. PMID: 25117158, DOI: 10.1111/acem.12415.Peer-Reviewed Original ResearchMeSH KeywordsAgedEmergency MedicineEmergency Service, HospitalGeriatricsGuidelines as TopicHumansUnited StatesConceptsEmergency Nurses AssociationAmerican Geriatrics SocietyGeriatric Emergency Department GuidelinesEmergency Department GuidelinesEmergency departmentEmergency physiciansAmerican CollegeEmergency careGeriatrics SocietyGeriatric health care providersStrained health care systemNurses AssociationDepartment guidelinesEmergency medicineEmergency medicine cliniciansCrowded emergency departmentsAcademic Emergency MedicineGeriatric Emergency DepartmentHealth care providersCost-effectiveness studiesHealth care systemMedicine cliniciansCare providersGeriatric careCare systemOptimal Older Adult Emergency Care: Introducing Multidisciplinary Geriatric Emergency Department Guidelines From the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine
Carpenter CR, Bromley M, Caterino JM, Chun A, Gerson LW, Greenspan J, Hwang U, John DP, Lyons WL, Platts-Mills TF, Mortensen B, Ragsdale L, Rosenberg M, Wilber ST, ACEP Geriatric Emergency Medicine Section A. Optimal Older Adult Emergency Care: Introducing Multidisciplinary Geriatric Emergency Department Guidelines From the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine. Annals Of Emergency Medicine 2014, 63: e1-e3. PMID: 24746436, DOI: 10.1016/j.annemergmed.2014.03.002.Peer-Reviewed Original ResearchConceptsGeriatric Emergency Department GuidelinesEmergency Department GuidelinesEmergency Nurses AssociationAmerican Geriatrics SocietyEmergency physiciansAmerican CollegeEmergency careGeriatrics SocietyNurses AssociationDepartment guidelinesEmergency medicineAcademic Emergency MedicinePhysiciansCare
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