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{ "pk": 17197, "title": "Effect of a Home Health and Safety Intervention on Emergency Department Use in the Frail Elderly: A Prospective Observational Study", "subtitle": null, "abstract": "Introduction: Geriatric patients are often frail and may lose independence through a variety of mechanisms including cognitive decline, reduced mobility, and falls. Our goal was to measure the effect of a multidisciplinary home health program that assessed frailty and safety and then coordinated ongoing delivery of community resources on short-term, all-cause emergency department (ED) utilization across three study arms that attempted to stratify frailty by fall risk.\nMethods: Subjects became eligible for this prospective observational study via one of three pathways: 1) by visiting the ED after a fall (2,757 patients); 2) by self-identifying as at risk for falling (2,787); or 3) by calling 9-1-1 for a “lift assist” after falling and being unable to get up (121). The intervention consisted of sequential home visits by a research paramedic who used standardized assessments of frailty and risk of falling (including providing home safety guidance), and a home health nurse who aligned resources to address the conditions found. Outcomes of interest were all-cause ED utilization at 30, 60, and 90 days post-intervention compared with subjects who enrolled via the same study pathway but declined the study intervention (controls).\nResults: Subjects in the fall-related ED visit arm were significantly less likely to have one or more subsequent ED encounters post-intervention than controls at 30 days (18.2% vs 29.2%, P<0.001); 60 days (27.5% vs 39.8%, P<0.001); and 90 days (34.6% vs 46.2%, P<0.001). In contrast, participants in the self-referral arm had no difference in ED encounters post-intervention compared to controls at 30, 60, or 90 days (P=0.30, 0.84, and 0.23, respectively). The size of the 9-1-1 call arm limited statistical power for analysis.\nConclusion: A history of a fall requiring ED evaluation appeared to be a useful marker of frailty. Subjects recruited through this pathway experienced less all-cause ED utilization over subsequent months after a coordinated community intervention than without it. The participants who only self-identified as at risk for falling had lower rates of subsequent ED utilization than those recruited in the ED after a fall and did not significantly benefit from the intervention.", "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": "Emergency Medical Services, falls, geriatrics," } ], "section": "Geriatrics", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/9q40q9tn", "frozenauthors": [ { "first_name": "Sandy", "middle_name": "", "last_name": "Bogucki MD, PhD", "name_suffix": "", "institution": "Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut", "department": "None" }, { "first_name": "Gina", "middle_name": "", "last_name": "Siddiqui MD", "name_suffix": "", "institution": "New York City Health and Hospitals, Elmhurst Hospital Center, Department of Emergency Medicine, Queens, New York", "department": "None" }, { "first_name": "Ryan", "middle_name": "", "last_name": "Carter MPH, MD", "name_suffix": "", "institution": "Our Lady of Fatima Hospital, Department of Emergency Medicine, North Providence, Rhode Island", "department": "None" }, { "first_name": "Joanne", "middle_name": "", "last_name": "McGovern, BS", "name_suffix": "", "institution": "Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut", "department": "None" }, { "first_name": "James", "middle_name": "", "last_name": "Dziura MPH PhD", "name_suffix": "", "institution": "Yale School of Medicine, Yale Center for Analytical Science, Department of Emergency Medicine and of Endocrinology, New Haven, Connecticut", "department": "None" }, { "first_name": "Geliang", "middle_name": "", "last_name": "Gan MPH PhD", "name_suffix": "", "institution": "Yale School of Public Health, Yale Center for Analytical Sciences, New Haven, Connecticut", "department": "None" }, { "first_name": "Fangyong", "middle_name": "", "last_name": "Li MS MPH", "name_suffix": "", "institution": "Yale School of Public Health, Yale Center for Analytical Sciences, New Haven, Connecticut", "department": "None" }, { "first_name": "Gina", "middle_name": "", "last_name": "Stover", "name_suffix": "", "institution": "Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut", "department": "None" }, { "first_name": "David", "middle_name": "C", "last_name": "Cone MD", "name_suffix": "", "institution": "University of Hawai’i, Honolulu, Hawaii", "department": "None" }, { "first_name": "Carolyn", "middle_name": "", "last_name": "Brokowski ALM MSc", "name_suffix": "", "institution": "Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut", "department": "None" }, { "first_name": "Daniel", "middle_name": "", "last_name": "Joseph MD", "name_suffix": "", "institution": "Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut", "department": "None" } ], "date_submitted": "2022-08-15T00:30:05+01:00", "date_accepted": "2022-08-15T00:30:05+01:00", "date_published": "2023-05-03T21:12:59+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/17197/galley/8693/download/" } ] }