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Citation
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Hwang U, Runels T, Han L, Gruber E, McQuown CM, Ragsdale L, Jetter E, Rossomano N, Javier D. Acad. Emerg. Med. 2023; ePub(ePub): ePub. |
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Abstract
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OBJECTIVES: In 2018, the US Department of Veterans Affairs (VA) Offices of Emergency Medicine and Geriatrics & Extended Care partnered to improve emergency care for older Veterans. A core team disseminated age-friendly models of care via education and standardization of practice with the goals of Geriatric Emergency Department (GED) accreditation. We compare rates of GED screening at VAs with GED implementation to those without.
METHODS: Observational evaluation of GED screening of older Veterans (≥65 age) at VA EDs from January 2018 - March 2022, during peak pandemic years. Data were extracted from the VA Corporate Data Warehouse of Veteran ED visit encounters to track documented GED screens, and Veteran demographic data. Generalized estimating equation models were used to compare screening completion across different levels of GED accreditation, adjusting for potential confounding.
RESULTS: During this period, over 1.07 million Veterans ≥ 65 age made 4.07 million VA ED visits. Mean age was 73.4 years (SD=7.2); 96.5% were male; 68% were White; and 89.9% made their index ED visit at a non-GED VA ED. As of early 2022, 50 of 111 VA EDs have achieved or applied for GED accreditation. During early 2022, 8.3% of all visits by older Veterans had at least one GED screen documented; 15% were screened at Level 1-3 GED versus 2.2% at non-GED facilities. Screens identifying older adults at risk for poor outcomes, for delirium, and for falls had the highest usage rates within VA GEDs. Veterans seen at Level 1 GEDs had a 76-fold greater odds of having a GED screen than at Level 3 GEDs (OR = 75.8 (95% CI 72.8, 79.0).
CONCLUSIONS: Through a partnership of VA Emergency Medicine and Geriatrics and Extended Care efforts, the VA has created, standardized, and disseminated a GED Model of Care, despite the pandemic. GED accreditation was associated with GED screen implementation, with Level 1 having the highest screening prevalence.
Language: en |