Department of Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA.
Medicine Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA.
J Am Geriatr Soc. 2022 Feb;70(2):601-608. doi: 10.1111/jgs.17572. Epub 2021 Nov 25.
We aim to describe the outcomes of Geriatric Emergency Room Innovations for Veterans (GERI-VET), the first comprehensive Veterans Affairs Geriatric ED program.
In this prospective observational cohort study at an urban Veterans Affairs Medical Center ED, participants included Veterans aged 65 years and older treated in the ED from January 7, 2017 to February 29, 2020. Veterans with an Identification of Seniors At Risk (ISAR) score >2 were considered eligible for GERI-VET, receiving geriatric screens and care coordination in addition to standard ED treatment. The control group included GERI-VET eligible Veterans who did not receive GERI-VET care. Propensity score matching was used to compare outcomes in the GERI-VET group (N = 725) and a matched control group (n = 725). Key measures included ED resource utilization, outpatient referrals, ED admission, and 30-day admission.
In the ED, the GERI-VET group received more consults to pharmacy (315 [43.4%] vs. 195 [26.9%], p < 0.001) and social work (399 [55.0%] vs. 132 [18.2%], p < 0.001). The GERI-VET group had higher referral rates to Geriatrics (64 [17.7%] vs. 18 [5.8%], p < 0.001) and Home Based Primary Care (110 [30.4%] vs. 24 [7.8%], p < 0.001). Key outcome measures included lower rates of ED admission (363 [50.1%] vs. 417 [n = 57.5%], p = 0.003) and 30-day hospital admission (412 [56.8%] vs. 464 [64.0%], p = 0.004) without increasing ED length of stay (5.4 ± 2.2 vs. 5.4 ± 2.6 h, p = 0.85) or 72-h ED revisits (23 [3.2%] vs. 16 [2.2%], p = 0.25) in the GERI-VET group.
A program designed to screen for geriatric syndromes and coordinate care among at-risk older Veterans was associated with increased multidisciplinary resource utilization and reduced ED and 30-day admissions without increasing ED length of stay or re-visitation.
我们旨在描述退伍军人老年急诊创新（GERI-VET）的结果，这是第一个全面的退伍军人事务老年急诊项目。
在这项针对城市退伍军人事务医疗中心急诊的前瞻性观察队列研究中，参与者包括 2017 年 1 月 7 日至 2020 年 2 月 29 日在急诊接受治疗的 65 岁及以上的退伍军人。具有老年人风险识别（ISAR）评分>2 的退伍军人被认为有资格接受 GERI-VET 治疗，除了接受急诊治疗外，还接受老年筛查和护理协调。对照组包括有资格接受 GERI-VET 治疗但未接受 GERI-VET 护理的退伍军人。采用倾向评分匹配比较 GERI-VET 组（N=725）和匹配对照组（n=725）的结果。关键措施包括急诊资源利用、门诊转介、急诊入院和 30 天入院。
在急诊室，GERI-VET 组接受了更多的药房咨询（315[43.4%]比 195[26.9%]，p<0.001）和社会工作咨询（399[55.0%]比 132[18.2%]，p<0.001）。GERI-VET 组向老年科（64[17.7%]比 18[5.8%]，p<0.001）和家庭初级保健（110[30.4%]比 24[7.8%]，p<0.001）的转介率更高。关键结果包括较低的急诊入院率（363[50.1%]比 417[n=57.5%]，p=0.003）和 30 天医院入院率（412[56.8%]比 464[64.0%]，p=0.004），而急诊留观时间（5.4±2.2 比 5.4±2.6 h，p=0.85）或 72 小时急诊复诊率（23[3.2%]比 16[2.2%]，p=0.25）在 GERI-VET 组没有增加。
一项旨在筛查老年综合征并协调高危老年退伍军人护理的计划，与增加多学科资源利用以及减少急诊和 30 天入院相关，而不会增加急诊留观时间或再次就诊。
