2023
Dissemination 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
Emergency 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
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 imagingGeriatric 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
Managing Older Adults with Presumed COVID‐19 in the Emergency Department: A Rational Approach to Rationing
Rosen T, Ferrante LE, Liu SW, Benton EA, Mulcare MR, Stern ME, Biese K, Hwang U, Sanon M. Managing Older Adults with Presumed COVID‐19 in the Emergency Department: A Rational Approach to Rationing. Journal Of The American Geriatrics Society 2020, 68: 1631-1635. PMID: 32574404, PMCID: PMC7361631, DOI: 10.1111/jgs.16651.Commentaries, Editorials and LettersAGS 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
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 patientsPROMIS Physical Function 10-Item Short Form for Older Adults in an Emergency Setting
Fox GWC, Rodriguez S, Rivera-Reyes L, Loo G, Hazan A, Hwang U. PROMIS Physical Function 10-Item Short Form for Older Adults in an Emergency Setting. The Journals Of Gerontology Series A 2019, 75: 1418-1423. PMID: 31251798, DOI: 10.1093/gerona/glz163.Peer-Reviewed Original ResearchConceptsPROMIS Physical FunctionPhysical functionOlder adultsPROMIS PFFunctional statusDaily livingED patients 65 yearsMean PROMIS-PF scorePatient-reported outcome measurementsPatients 65 yearsOutcomes Measurement Information SystemPROMIS PF scoresGeneral functional statusQuality of lifeMeasurement Information SystemShort formOlder adult populationSeverity of impairmentAssessment of functionKatz IndexEmergency settingHospital useOutcome measurementsPF scoresAdult populationAnalgesic prescribing trends in a national sample of older veterans with osteoarthritis
Trentalange M, Runels T, Bean A, Kerns RD, Bair MJ, Brody AA, Brandt CA, Hwang U. Analgesic prescribing trends in a national sample of older veterans with osteoarthritis. Pain 2019, Publish Ahead of Print: &na;. PMID: 30913167, PMCID: PMC9486693, DOI: 10.1097/j.pain.0000000000001509.Peer-Reviewed Original ResearchConceptsPain intensity ratingsAnalgesic prescriptionPrescribing trendsOlder veteransIntensity ratingsNonopioid analgesic prescribingPatterns of opioidPre-post observational studyReported pain intensityInterrupted time seriesOlder U.S. veteransAcetaminophen prescriptionsAnalgesic classTotal prescribingAnalgesic prescribingOpioid prescribingPain intensityDrug prescribingObservational studyPrescribingU.S. veteransPrescribing programmeOsteoarthritisStudy periodBinomial regression models
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
Using music to reduce anxiety among older adults in the emergency department: a randomized pilot study
Belland L, Rivera-Reyes L, Hwang U. Using music to reduce anxiety among older adults in the emergency department: a randomized pilot study. Journal Of Integrative Medicine 2017, 15: 450-455. PMID: 29103414, DOI: 10.1016/s2095-4964(17)60341-8.Peer-Reviewed Original ResearchConceptsRandomized pilot studyState-Trait Anxiety InventoryOlder adultsRoutine careIntervention subjectsPilot studyAcademic tertiary medical centerOlder ED patientsEmergency department visitsTertiary medical centerEffects of musicAnxiety levelsGeriatric EDDepartment visitsPrimary outcomeED patientsEmergency departmentControl subjectsStudy protocolMedical CenterTreatment groupsControl groupSTAI scoresMin of musicAnxiety InventoryBouncing 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
Regional Nerve Blocks Improve Pain and Functional Outcomes in Hip Fracture: A Randomized Controlled Trial
Morrison RS, Dickman E, Hwang U, Akhtar S, Ferguson T, Huang J, Jeng CL, Nelson BP, Rosenblatt MA, Silverstein JH, Strayer RJ, Torrillo TM, Todd KH. Regional Nerve Blocks Improve Pain and Functional Outcomes in Hip Fracture: A Randomized Controlled Trial. Journal Of The American Geriatrics Society 2016, 64: 2433-2439. PMID: 27787895, PMCID: PMC5173407, DOI: 10.1111/jgs.14386.Peer-Reviewed Original ResearchConceptsContinuous fascia iliaca blockFascia iliaca blockOpioid side effectsFemoral nerve blockNerve blockRegional nerve blocksHip fractureIntervention participantsPOD 3Emergency physiciansSide effectsMorphine sulfate equivalentsPostoperative day 3Emergency department admissionsNew York HospitalStair climbing abilityConventional analgesicsPain scoresED presentationsStandard analgesicsControlled TrialsDepartment admissionsFunctional outcomeIntervention groupYork HospitalFeasibility of nurses measuring gait speed in older community-dwelling Emergency Department patients
Tucker PW, Evans DD, Clevenger CK, Ardisson M, Hwang U. Feasibility of nurses measuring gait speed in older community-dwelling Emergency Department patients. Geriatric Nursing 2016, 37: 453-457. PMID: 27477084, DOI: 10.1016/j.gerinurse.2016.06.015.Peer-Reviewed Original ResearchConceptsGait speedCommunity-dwelling adults 65 yearsDescriptive pilot projectED screening toolsED social workersFeasibility of nursesGait speed assessmentRoutine nursing assessmentRoutine nursing practiceEmergency department patientsAdults 65 yearsAdverse eventsDepartment patientsNursing assessmentUnfavorable outcomeED treatmentDisposition planningPatientsNursing practiceScreening toolNursesIndividualized resourcesObjective measuresSpeed assessmentSocial workersA 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 effect of surgical consult in the treatment of abdominal pain in older adults in the ED
Roberts ES, Belland L, Rivera-Reyes L, Hwang U. The effect of surgical consult in the treatment of abdominal pain in older adults in the ED. The American Journal Of Emergency Medicine 2016, 34: 1524-1527. PMID: 27241564, PMCID: PMC5027841, DOI: 10.1016/j.ajem.2016.05.010.Peer-Reviewed Original ResearchConceptsPain score reductionScore reductionAbdominal painSurgical consultAnalgesic administrationAnalgesic medicationConsult patientsEmergency departmentOlder adultsAdministration of analgesicsProspective cohort studyEmergency Severity IndexRace/ethnicityDecreased administrationCohort studyOlder patientsSecondary data analysisPatientsPainAdministrationConsultsSeverity IndexAnalgesicsOpioidsMedicationsIncreased 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 effortsDepartmentHoursPatientsThe 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