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 prioritiesAdapting Emergency Care for Persons Living With Dementia: Results of the Geriatric Emergency Care Applied Research Network Scoping Review and Consensus Conference
Carpenter CR, Dresden SM, Shah MN, Hwang U. Adapting Emergency Care for Persons Living With Dementia: Results of the Geriatric Emergency Care Applied Research Network Scoping Review and Consensus Conference. Journal Of The American Medical Directors Association 2022, 23: 1286-1287. PMID: 35940679, DOI: 10.1016/j.jamda.2022.05.016.Peer-Reviewed Original ResearchThe 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 researchAssociation 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
System-level Variability in Trauma Center Utilization for Seriously Injured Older Adults
Ordoobadi A, Castillo-Angeles M, Tabata-Kelly M, Jenkins P, Hwang U, Cooper Z, Jarman M. System-level Variability in Trauma Center Utilization for Seriously Injured Older Adults. Journal Of Surgical Research 2024, 305: 10-18. PMID: 39616785, DOI: 10.1016/j.jss.2024.10.047.Peer-Reviewed Original ResearchInjured older adultsTrauma service areasSystem-level factorsOlder adultsMultivariable hierarchical logistic regressionHierarchical logistic regressionTrauma centerLogistic regressionRate of undertriageLevel IRetrospective cross-sectional studyCross-sectional studyUnited States countiesHospital destinationInjury characteristicsTrauma center utilizationMedicare dataSystem-level variablesPatient demographicsRandom interceptStates countiesUndertriagePrimary outcomeRural regionsCenter utilizationScreening 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 coefficientDepartmentDyadsPatientsImpairmentMoving beyond tokenism: Sustaining engagement of persons living with dementia in identifying emergency research priorities
Sandoval J, Gilmore‐Bykovskyi A, Carpenter C, Shah M, Dussetschleger J, Dresden S, Ellenbogen M, Gil H, Jaspal N, Jobe D, Vann A, Webb T, Hwang U. Moving beyond tokenism: Sustaining engagement of persons living with dementia in identifying emergency research priorities. Journal Of The American Geriatrics Society 2024 PMID: 39576051, DOI: 10.1111/jgs.19269.Peer-Reviewed Original ResearchCare partnersEmergency careResearch prioritiesCommunity-engaged approachCare of personsVirtual consensus conferenceEngagement of personsConsensus conferenceSemi-structured interviewsDementia carePLWDsFacilitation techniquesResearch partnersCareCognitive impairmentIdentification of research gapsDementiaParticipantsBest practicesSustained engagementMultiple opportunitiesConsensus buildingPriorityConsensus participantsEmergencyEnd‐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 outcomeDaily care hours among caregivers of older emergency department patients with dementia and undiagnosed cognitive impairment
Galske J, Chera T, Hwang U, Monin J, Venkatesh A, Lam K, Leggett A, Gettel C. Daily care hours among caregivers of older emergency department patients with dementia and undiagnosed cognitive impairment. Journal Of The American Geriatrics Society 2024, 72: 3261-3264. PMID: 38970304, PMCID: PMC11461120, DOI: 10.1111/jgs.19062.Peer-Reviewed Original ResearchTotal 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 listPatient‐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 IndexScaling 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 approachDementia risk analysis using temporal event modeling on a large real-world dataset
Taylor R, Gilson A, Chi L, Haimovich A, Crawford A, Brandt C, Magidson P, Lai J, Levin S, Mecca A, Hwang U. Dementia risk analysis using temporal event modeling on a large real-world dataset. Scientific Reports 2023, 13: 22618. PMID: 38114545, PMCID: PMC10730574, DOI: 10.1038/s41598-023-49330-8.Peer-Reviewed Original ResearchPatterns 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 data