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{
    "pk": 10319,
    "title": "Feasibility of an ED-to-Home Intervention to Engage Patients: A Mixed-Methods Investigation",
    "subtitle": null,
    "abstract": "Introduction:\n Older, chronically ill patients with limited health literacy are often under-engagedin managing their health and turn to the emergency department (ED) for healthcare needs. Wetested the impact of an ED-initiated coaching intervention on patient engagement and follow-updoctor visits in this high-risk population. We also explored patients’ care-seeking decisions.\nMethods:\n We conducted a mixed-methods study including a randomized controlled trial andin-depth interviews in two EDs in northern Florida. Participants were chronically ill older EDpatients with limited health literacy and Medicare as a payer source. Patients were assignedto an evidence-based coaching intervention (n= 35) or usual post-ED care (n= 34). Qualitativeinterviews (n=9) explored patients’ reasons for ED use. We assessed average between-groupdifferences in patient engagement over time with the Patient Activation Measure (PAM) tool,using logistic regression and a difference-in-difference approach. Between-group differences infollow-up doctor visits were determined. We analyzed qualitative data using open coding andthematic analysis.\nResults:\n PAM scores fell in both groups after the ED visit but fell signi ficantly more in “usualcare” (average decline -4.64) than “intervention” participants (average decline -2.77) (β=1.87,p=0.043). There were no between-group differences in doctor visits. Patients described wellinformedreasons for ED visits including onset and severity of symptoms, lack of timely provideraccess, and immediate and comprehensive ED care.\nConclusion:\n The coaching intervention significantly reduced declines in pati ent engagementobserved after usual post-ED care. Patients reported well-informed reasons for ED use andwill likely continue to make ED visits unless strategies, such as ED-initiated coaching, areimplemented to help vulnerable patients better manage their health and healthcare.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Health Literacy"
        },
        {
            "word": "Patient Engagement"
        },
        {
            "word": "emergency department"
        },
        {
            "word": "Care Transitions"
        },
        {
            "word": "mixed methods"
        }
    ],
    "section": "Health Outcomes",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/78q8t832",
    "frozenauthors": [
        {
            "first_name": "Jessica",
            "middle_name": "R.",
            "last_name": "Schumacher",
            "name_suffix": "",
            "institution": "University of Florida, Department of Emergency Medicine, Gainesville, Florida",
            "department": "None"
        },
        {
            "first_name": "Barbara",
            "middle_name": "J.",
            "last_name": "Lutz",
            "name_suffix": "",
            "institution": "University of North Carolina-Wilmington, College of Health and Human Services, School of Nursing, Wilmington, North Carolina",
            "department": "None"
        },
        {
            "first_name": "Allyson",
            "middle_name": "G.",
            "last_name": "Hall",
            "name_suffix": "",
            "institution": "University of Alabama at Birmingham, Department of Health Services Administration, Birmingham, Alabama",
            "department": "None"
        },
        {
            "first_name": "Jesse",
            "middle_name": "M.",
            "last_name": "Pines",
            "name_suffix": "",
            "institution": "The George Washington University School of Medicine, Department of Emergency Medicine and Health Policy & Management, Washington, DC",
            "department": "None"
        },
        {
            "first_name": "Andrea",
            "middle_name": "L.",
            "last_name": "Jones",
            "name_suffix": "",
            "institution": "University of North Carolina-Wilmington, College of Health and Human Services, School of Social Work, Wilmington, North Carolina",
            "department": "None"
        },
        {
            "first_name": "Phyllis",
            "middle_name": "",
            "last_name": "Hendry",
            "name_suffix": "",
            "institution": "University of Florida, College of Medicine, Department of Emergency Medicine, Jacksonville, Florida",
            "department": "None"
        },
        {
            "first_name": "Colleen",
            "middle_name": "",
            "last_name": "Kalynych",
            "name_suffix": "",
            "institution": "University of Florida, College of Medicine, Department of Emergency Medicine, Jacksonville, Florida",
            "department": "None"
        },
        {
            "first_name": "Donna",
            "middle_name": "L.",
            "last_name": "Carden",
            "name_suffix": "",
            "institution": "University of Florida, Department of Emergency Medicine, Gainesville, Florida",
            "department": "None"
        }
    ],
    "date_submitted": "2016-09-16T23:02:09Z",
    "date_accepted": "2016-09-16T23:02:09Z",
    "date_published": "2017-04-19T19:57:17Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/10319/galley/5674/download/"
        }
    ]
}