Try a new search

Format these results:

Searched for:

person:grudzc01

Total Results:

149


Emergency and post-emergency care of older adults with Alzheimer's disease/Alzheimer's disease related dementias

Hill, Jacob D; Schmucker, Abigail M; Siman, Nina; Goldfeld, Keith S; Cuthel, Allison M; Chodosh, Joshua; Bouillon-Minois, Jean-Baptiste; Grudzen, Corita R
BACKGROUND:The emergency department (ED) is a critical juncture in the care of persons living with dementia (PLwD), as they have a high rate of hospital admission, ED revisits, and subsequent inpatient stays. We examine ED disposition of PLwD compared with older adults with non-dementia chronic disease as well as healthcare utilization and survival. METHODS:Medicare claims data were used to identify community-dwelling older adults 66+ years old from 34 hospitals with either Alzheimer's disease/Alzheimer's disease related dementias (AD/ADRD) or a non-AD/ADRD chronic condition between January 1, 2014, and December 31, 2018. We compared ED disposition at the index visit, as well as healthcare utilization and mortality in the 12 months following an index ED visit, and adjusted for age, gender, and risk of mortality. RESULTS:There were 29,626 patients in the AD/ADRD sample, and 317,046 in the comparison sample. The AD/ADRD sample was older (82.4 years old [SD: 8.2] vs. 76.0 years old [SD: 7.7]) and had more female patients (59.9% vs. 54.7%). The AD/ADRD sample was more likely to experience ED disposition to acute care (OR 1.039, p < 0.001, 95% CI 1.029-1.050), to have an ED revisit (OR 1.077, p < 0.001, 95% CI 1.066-1.087), and an inpatient stay in the subsequent 12 months (OR 1.085, p < 0.001, 95% CI 1.075-1.095). ED disposition to hospice was low in both samples (0.2%). AD/ADRD patients had a higher risk of mortality (OR 1.099, p < 0.001, 95% CI 1.091-1.107) and high short-term mortality (31.9% within 12 months) than those without AD/ADRD (15.3% within 12 months). CONCLUSIONS:PLwD who visit the ED have high short-term mortality. Despite this, disposition to acute care, ED revisits, and inpatient stays, rather than hospice, remain the predominant mode of care delivery. Transition directly from the ED to hospice for PLwD is rare.
PMID: 35612546
ISSN: 1532-5415
CID: 5247992

Characterization of older adults with cancer seeking acute emergency department care: A prospective observational study

Bischof, Jason J; Elsaid, Mohamed I; Bridges, John F P; Rosko, Ashley E; Presley, Carolyn J; Abar, Beau; Adler, David; Bastani, Aveh; Baugh, Christopher W; Bernstein, Steven L; Coyne, Christopher J; Durham, Danielle D; Grudzen, Corita R; Henning, Daniel J; Hudson, Matthew F; Klotz, Adam; Lyman, Gary H; Madsen, Troy E; Reyes-Gibby, Cielito C; Rico, Juan Felipe; Ryan, Richard J; Shapiro, Nathan I; Swor, Robert; Thomas, Charles R; Venkat, Arvind; Wilson, Jason; Yeung, Sai-Ching Jim; Yilmaz, Sule; Caterino, Jeffrey M
INTRODUCTION/BACKGROUND:Disparities in care of older adults in cancer treatment trials and emergency department (ED) use exist. This report provides a baseline description of older adults ≥65 years old who present to the ED with active cancer. MATERIALS AND METHODS/METHODS:Planned secondary analysis of the Comprehensive Oncologic Emergencies Research Network observational ED cohort study sponsored by the National Cancer Institute. Of 1564 eligible adults with active cancer, 1075 patients were prospectively enrolled, of which 505 were ≥ 65 years old. We recruited this convenience sample from eighteen participating sites across the United States between February 1, 2016 and January 30, 2017. RESULTS:Compared to cancer patients younger than 65 years of age, older adults were more likely to be transported to the ED by emergency medical services, have a higher Charlson Comorbidity Index score, and be admitted despite no significant difference in acuity as measured by the Emergency Severity Index. Despite the higher admission rate, no significant difference was noted in hospitalization length of stay, 30-day mortality, ED revisit or hospital admission within 30 days after the index visit. Three of the top five ED diagnoses for older adults were symptom-related (fever of other and unknown origin, abdominal and pelvic pain, and pain in throat and chest). Despite this, older adults were less likely to report symptoms and less likely to receive symptomatic treatment for pain and nausea than the younger comparison group. Both younger and older adults reported a higher symptom burden on the patient reported Condensed Memorial Symptom Assessment Scale than to ED providers. When treating suspected infection, no differences were noted in regard to administration of antibiotics in the ED, admissions, or length of stay ≤2 days for those receiving ED antibiotics. DISCUSSION/CONCLUSIONS:We identified several differences between older (≥65 years old) and younger adults with active cancer seeking emergency care. Older adults frequently presented for symptom-related diagnoses but received fewer symptomatic interventions in the ED suggesting that important opportunities to improve the care of older adults with cancer in the ED exist.
PMID: 35718667
ISSN: 1879-4076
CID: 5281752

Feasibility of the Transport PLUS intervention to improve the transitions of care for patients transported home by ambulance: a non-randomized pilot study

Munjal, Kevin G; Yeturu, Sai Kaushik; Chapin, Hugh H; Tan, Nadir; Gregoriou, Diana; Garcia, Daniela; Grudzen, Corita; Hwang, Ula; Morano, Barbara; Neher, Hayley; Gorbenko, Ksenia; Youngblood, Glen; Misra, Anjali; Dietrich, Staley; Gonzalez, Cyndi; Appel, Giselle; Jacobs, Erica; Siu, Albert; Richardson, Lynne D
BACKGROUND:The growing population of patients over the age of 65 faces particular vulnerability following discharge after hospitalization or an emergency room visit. Specific areas of concern include a high risk for falls and poor comprehension of discharge instructions. Emergency medical technicians (EMTs), who frequently transport these patients home from the hospital, are uniquely positioned to aid in mitigating transition of care risks and are both trained and utilized to do so using the Transport PLUS intervention. METHODS:Existing literature and focus groups of various stakeholders were utilized to develop two checklists: the fall safety assessment (FSA) and the discharge comprehension assessment (DCA). EMTs were trained to administer the intervention to eligible patients in the geriatric population. Using data from the checklists, follow-up phone calls, and electronic health records, we measured the presence of hazards, removal of hazards, the presence of discharge comprehension issues, and correction or reinforcement of comprehension. These results were validated during home visits by community health workers (CHWs). Feasibility outcomes included patient acceptance of the Transport PLUS intervention and accuracy of the EMT assessment. Qualitative feedback via focus groups was also obtained. Clinical outcomes measured included 3-day and 30-day readmission or ED revisit. RESULTS:One-hundred three EMTs were trained to administer the intervention and participated in 439 patient encounters. The intervention was determined to be feasible, and patients were highly amenable to the intervention, as evidenced by a 92% and 74% acceptance rate of the DCA and FSA, respectively. The majority of patients also reported that they found the intervention helpful (90%) and self-reported removing 40% of fall hazards; 85% of such changes were validated by CHWs. Readmission/revisit rates are also reported. CONCLUSIONS:The Transport PLUS intervention is a feasible, easily implemented tool in preventative community paramedicine with high levels of patient acceptance. Further study is merited to determine the effectiveness of the intervention in reducing rates of readmission or revisit. A randomized control trial has since begun utilizing the knowledge gained within this study.
PMCID:9354351
PMID: 35932067
ISSN: 2055-5784
CID: 5288422

Household Income and Older Adult Population Predict Number of Integrative Medicine Providers Around US Hospitals: An Environmental Scan Study

Hill, Jacob D.; Schmucker, Abigail M.; Siman, Nina; Goldfeld, Keith S.; Cuthel, Allison M.; Adeyemi, Oluwaseun J.; Edwards, Eliot; Bouillon-Minois, Jean Baptiste; Grudzen, Corita R.
Background: Integrative medicine (IM) is a growing subspecialty among the American healthcare system, but little is known about geographical and sociodemographic variability in access to services. Objective: To better understand access to IM healthcare services, we aim to: 1.) document the number of IM providers within the hospital service area (HSA) of various hospitals across the United States (US) and, 2.) explore the relationship between age, income, and race as predictors of the number of IM providers. Methods: We conducted an environmental scan to document the number of IM providers including naturopathic, acupuncture, chiropractic, and massage therapy providers within the HSA of 16 US hospitals using state and national search databases. We examined predictors of the number of providers per HSA using population and demographic data from the U.S. Census Bureau. Search database quality was evaluated using the Center for Disease Control and Prevention Clear Communication Index. Results: The number of IM providers varied from 11.6 "“ 67.4 providers/100,000 persons. Massage therapists were the most prevalent (n = 13.8/100,000), followed by chiropractors (n = 5.2/100,000), acupuncturists (n = 4.6/100,000), and naturopathic physicians (n =.5/100,000). Higher average household income and population >65 years old were associated with more IM providers within an HSA (Rate Ratio (RR) 4.22, 95% CI 1.49-12.01; and 1.14, 1.05 - 1.24, respectively). In addition, the quality of publicly available search databases varied widely among US states (4.84 - 8.00/10), but less so among IM provider types (6.21 - 7.57/10). Conclusions: The high variability in number of IM providers and search database quality among various HSAs across the US warrants further investigation into factors influencing access to services. Our findings regarding income and older adult population raise concern for inequitable access to care, but are also promising when considering the increasing demand for healthcare services among the older adult population.
SCOPUS:85136573307
ISSN: 2164-957x
CID: 5329402

Mapping the Future for Research in Emergency Medicine Palliative Care: A Research Roadmap

Aaronson, Emily L; Wright, Rebecca J; Ritchie, Christine S; Grudzen, Corita R; Ankuda, Claire K; Bowman, Jason K; Kuntz, Joanne G; Ouchi, Kei; George, Naomi; Jubanyik, Karen; Bright, Leah E; Bickel, Kathleen; Isaacs, Eric; Petrillo, Laura A; Carpenter, Christopher; Goett, Rebecca; LaPointe, Lauren; Owens, Darrell; Manfredi, Rita; Quest, Tammie
BACKGROUND:The intersection of Emergency Medicine (EM) and Palliative Care (PC) has been recognized as an essential area of focus, with evidence suggesting that increased integration improves outcomes. This has resulted in increased research in EM PC. No current framework exists to help guide investigation and innovation. OBJECTIVE:The objective was to convene a working group to develop a roadmap that would help provide focus and prioritization for future research. METHODS:Participants were identified based on clinical, operation, policy and research expertise in both EM and PC, and spanned physician, nursing, social work and patient perspectives. The research roadmap setting process consisted of three distinct phases that were time staggered over 12 months, and facilitated through three live video convenings, asynchronous input via an online document, and a series of smaller video convenings of workgroups focused on specific topics. RESULTS:Gaps in the literature were identified and informed the four key areas for future research. Consensus was reached on these domains and the associated research questions in each domain to help guide future study. The key domains included work focused on the value imperative for PC in the Emergency setting, models of care delivery, disparities, and measurement of impact and efficacy. Additionally, the group identified key methodological considerations for doing work at the intersection of EM and PC. CONCLUSION/CONCLUSIONS:There are several key domains and associated questions that can help guide future research in ED PC. Focus on these areas, and answering these questions, offers the potential to improve the emergency care of patients with palliative care needs.
PMID: 35368129
ISSN: 1553-2712
CID: 5204772

Palliative Care Needs and Clinical Outcomes of Patients with Advanced Cancer in the Emergency Department

Yilmaz, Sule; Grudzen, Corita R; Durham, Danielle D; McNaughton, Caroline; Marcelin, Isabelle; Abar, Beau; Adler, David; Bastani, Aveh; Baugh, Christopher W; Bernstein, Steven L; Bischof, Jason J; Coyne, Christopher J; Henning, Daniel J; Hudson, Matthew F; Klotz, Adam; Lyman, Gary H; Madsen, Troy E; Pallin, Daniel J; Reyes-Gibby, Cielito; Rico, Juan Felipe; Ryan, Richard J; Shapiro, Nathan I; Swor, Robert; Thomas, Charles R; Venkat, Arvind; Wilson, Jason; Yeung, Sai-Ching Jim; Caterino, Jeffrey M
PMID: 35559758
ISSN: 1557-7740
CID: 5214912

Leading from the Heart

Boss, Renee D; Creutzfeldt, Claire J; Fausto, James A; Gonzales, Matthew J; Grudzen, Corita R; Hurd, Caroline J; Kamal, Arif H; Lam, Daniel Y; Lindvall, Charlotta; Merlin, Jessica S; Reinke, Lynn F; Roeland, Eric J; Rosenberg, Abby R; Sanders, Justin J; Smith, Cardinale B; Sullivan, Donald R; Tjia, Jennifer; Walling, Anne M
PMID: 35595379
ISSN: 1873-6513
CID: 5235512

Knowledge and Attitudes Toward Hospice and Palliative Care: Instrument Validation Among Emergency Providers

Adeyemi, Oluwaseun J; Bouillon-Minois, Jean-Baptiste; Siman, Nina; Cuthel, Allison M; Goldfeld, Keith S; Grudzen, Corita R
PMID: 35549544
ISSN: 1938-2715
CID: 5214622

Locating Advance Care Planning Documents in the Electronic Health Record during Emergency Care

Pyles, Olivia; Hritz, Christopher M; Gulker, Peg; Straveler, Jansi D; Grudzen, Corita R; Briggs, Cole; Southerland, Lauren T
CONTEXT/BACKGROUND:Emergency Departments (EDs) care for people at critical junctures in their illness trajectories, but Advanced Care Planning (ACP) seldom happens during ED visits. One barrier to incorporating patient goals into ED care may be locating ACP documents in the electronic health record (EHR). OBJECTIVES/OBJECTIVE:To determine the ease and accuracy of locating ACP documentation in the EHR during an ED visit. METHODS:Academic ED with 82,000 visits per year. The EHR system includes a Storyboard with the patient's code status and a link to ACP documents. A real-time chart audit study was performed of ED patients who were either ≥65 years old or had a cancer diagnosis. Data elements included age, Emergency Severity Index, ACP document location(s) in the EHR, Storyboard accuracy, ED code status orders, and discussions of ACP or code status. RESULTS:Of the 160 audited charts, 51 (32%) were for adults <65 years old with a cancer diagnosis. Code status was discussed and updated during the ED visit in 68% (n=108). ACP documents were found in 3 different EHR places. Only 30% (n=48) had ACP documents in the EHR, and of these (22%, n=13) were found in only one of the three EHR locations. The Storyboard was inaccurate for 5% (n=8). ED case managers frequently discussed APC documentation (78%, 43/55 charts). CONCLUSIONS:Even under optimal conditions with social work availability, ACP documents are lacking for ED patients. Multiple potential locations of ACP documents and inaccurate linkage to the Storyboard are potentially addressable barriers to ACP conversations.
PMID: 34896277
ISSN: 1873-6513
CID: 5109562

Providing Hearing Assistance to Veterans in the Emergency Department: A Qualitative Study

Dickson, Victoria Vaughan; Blustein, Jan; Weinstein, Barbara; Goldfeld, Keith; Radcliffe, Kate; Burlingame, Madeleine; Grudzen, Corita R; Sherman, Scott E; Smilowitz, Jessica; Chodosh, Joshua
INTRODUCTION/BACKGROUND:Effective communication is essential to good health care, and hearing loss disrupts patient-provider communication. For the more than 2 million veterans with severe hearing loss, communication is particularly challenging in noisy health care environments such as emergency departments. The purpose of this qualitative study was to describe patient and provider perspectives of feasibility and potential benefit of providing a hearing assistance device, a personal amplifier, during visits to an emergency department in an urban setting affiliated with the Department of Veterans Affairs. METHODS:This qualitative descriptive study was conducted in parallel with a randomized controlled study. We completed a semistructured interview with 11 veterans and 10 health care providers to elicit their previous experiences with patient-provider communication in the ED setting and their perspectives on hearing screening and using the personal amplifier in the emergency department. Interview data were analyzed using content analysis and Atlas.ti V8.4 software (Scientific Software Development GmbH, Berlin, Germany). RESULTS:The veteran sample (n = 11) had a mean age of 80.3 years (SD = 10.2). The provider sample included 7 nurses and 3 physicians. In the ED setting, hearing loss disrupts patient-provider communication. Screening for hearing loss in the emergency department was feasible except in urgent/emergent cases. The use of the personal amplifier made communication more effective and less effortful for both veterans and providers. DISCUSSION/CONCLUSIONS:Providing the personal amplifier improved the ED experience for veterans and offers a promising intervention that could improve health care quality and safety for ED patient populations.
PMID: 35172928
ISSN: 1527-2966
CID: 5285562