Care transitions and social needs: A Geriatric Emergency care Applied Research (GEAR) Network scoping review and consensus statement

Cameron J Gettel; Corrine I Voils; Alycia A Bristol; Lynne D Richardson; Teresita M Hogan; Abraham A Brody; Micaela N Gladney; Joe Suyama; Luna C Ragsdale; Christine L Binkley; Carmen L Morano; Justine Seidenfeld; Nada Hammouda; Kelly J Ko; Ula Hwang; Susan N Hastings

doi:10.1111/acem.14360

Care transitions and social needs: A Geriatric Emergency care Applied Research (GEAR) Network scoping review and consensus statement

Acad Emerg Med. 2021 Dec;28(12):1430-1439. doi: 10.1111/acem.14360. Epub 2021 Aug 23.

Authors

Cameron J Gettel^{1

2}, Corrine I Voils^{3

4}, Alycia A Bristol⁵, Lynne D Richardson^{6

7

8}, Teresita M Hogan⁹, Abraham A Brody¹⁰, Micaela N Gladney¹¹, Joe Suyama¹², Luna C Ragsdale^{13

14}, Christine L Binkley¹⁵, Carmen L Morano¹⁶, Justine Seidenfeld¹³, Nada Hammouda⁶, Kelly J Ko¹⁷, Ula Hwang^{1

18}, Susan N Hastings^{11

19

20

21

22}

Affiliations

¹ Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
² National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
³ William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA.
⁴ Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
⁵ College of Nursing, University of Utah, Salt Lake City, Utah, USA.
⁶ Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁷ Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁸ Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁹ Department of Medicine, Section of Emergency Medicine, The University of Chicago School of Medicine, Chicago, Illinois, USA.
¹⁰ Hartford Institute for Geriatric Nursing, New York University Rory Meyers College of Nursing, New York, New York, USA.
¹¹ Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA.
¹² Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹³ Department of Surgery, Division of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
¹⁴ Department of Emergency Medicine, Durham VA Health Care System, Durham, North Carolina, USA.
¹⁵ Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
¹⁶ School of Social Welfare, University at Albany, State University of New York, Albany, New York, USA.
¹⁷ West Health Institute, La Jolla, California, USA.
¹⁸ Geriatrics Research, Education, and Clinical Center, James J. Peters VAMC, Bronx, New York, USA.
¹⁹ Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
²⁰ Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, North Carolina, USA.
²¹ Center for the Study of Human Aging and Development, Duke University School of Medicine, Durham, North Carolina, USA.
²² Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.

Abstract

Objectives: Individual-level social needs have been shown to substantially impact emergency department (ED) care transitions of older adults. The Geriatric Emergency care Applied Research (GEAR) Network aimed to identify care transition interventions, particularly addressing social needs, and prioritize future research questions.

Methods: GEAR engaged 49 interdisciplinary stakeholders, derived clinical questions, and conducted searches of electronic databases to identify ED discharge care transition interventions in older adult populations. Informed by the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) framework, data extraction and synthesis of included studies included the degree that intervention components addressed social needs and their association with patient outcomes. GEAR convened a consensus conference to identify topics of highest priority for future care transitions research.

Results: Our search identified 248 unique articles addressing care transition interventions in older adult populations. Of these, 17 individual care transition intervention studies were included in the current literature synthesis. Overall, common care transition interventions included coordination efforts, comprehensive geriatric assessments, discharge planning, and telephone or in-person follow-up. Fourteen of the 17 care transition intervention studies in older adults specifically addressed at least one social need within the PRAPARE framework, most commonly related to access to food, medicine, or health care. No care transition intervention addressing social needs in older adult populations consistently reduced subsequent health care utilization or other patient-centered outcomes. GEAR stakeholders identified that determining optimal outcome measures for ED-home transition interventions was the highest priority area for future care transitions research.

Conclusions: ED care transition intervention studies in older adults frequently address at least one social need component and exhibit variation in the degree of success on a wide array of health care utilization outcomes.

Keywords: care transitions; consensus statement; geriatric emergency medicine; scoping review; social needs.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Review

MeSH terms

Aged
Emergency Medical Services*
Emergency Service, Hospital
Humans
Patient Discharge
Patient Transfer
Transitional Care*

Abstract

Publication types

MeSH terms

Grants and funding