老年急诊护理应用研究标准化研究（GEARSS）：一项针对老年急诊科患者的观察性研究。
The Geriatric Emergency Care Applied Research Standardization Study (GEARSS): An Observational Study of Older Emergency Department Patients.
作者信息
Hwang Ula, Sifnugel Natalia, Cohen Inessa, Han Ling, Araujo Katy, Bianco Luann M, Brandt Cynthia A, Capelli Sandra, Carpenter Christopher R, Cruz Daniel S, Dresden Scott M, Fishman Ivy L, Gipson Katrina, Hastings S Nicole, Hung William W, Kang Raymond, Lockhart Mechelle, Meeker Daniella, Ohuabunwa Ugochi, Ottilie-Kovelman Sierra, Partridge Caitlin, Platts-Mills Timothy F, Sandoval Jacqueline, Taylor Zachary, Tomasino Debra F, Vaughan Camille P
机构信息
Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York, USA.
Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA.
出版信息
Acad Emerg Med. 2025 Jul 12. doi: 10.1111/acem.70101.
OBJECTIVES
Multicenter research of geriatric emergency department (GED) care remains limited. Our objectives were to: 1. Prospectively collect data prioritized by the Geriatric Emergency care Applied Research (GEAR) network, a transdisciplinary taskforce for GED care, and create a multicenter GED research repository of prospective and electronic health record (EHR) data, 2. Assess concordance between prospective and EHR data.
METHODS
The GEAR Standardization Study (GEARSS) is a multicenter, prospective study of older emergency department (ED) patients (65+) focusing on the 4Ms of age-friendly care (mobility, medication safety, mentation, what matters) and elder mistreatment. Demographic and clinical data were collected via interviews by trained research assistants (RA) on Days 0, 4, 30, and 90 and linked to EHR. Prevalence of chronic comorbidities and incident delirium were measured and reported using descriptive statistics. Prospective and EHR data concordance was assessed with Cohen's Kappa.
RESULTS
999 participants were recruited from 5 EDs (3/25/2021-6/30/2022) across 3 institutions: Grady Health System, Northwestern Memorial Hospital, and Yale New Haven Health. The cohort was 57.0% female, 55.2% White, 39.1% Black, and 3.4% Hispanic, and the mean age was 75.1 years. For rheumatologic disease, peptic ulcer disease, diabetes, renal disease, and cancer, prevalence differed between prospective and EHR data by > 10%. About two-thirds of participants were at risk for falls. Concordance between prospective and EHR data was good for ethnicity (K = 0.73); excellent for sex (K = 1.00), age (K = 1.00), and race (K = 0.98); fair for disposition (K = 0.53); slight for ED observation status (K = 0.33) and dementia diagnosis (K = 0.24); poor for delirium presence (K = 0.07).
CONCLUSION
In GEARSS, demographic variables aligned strongly between prospective and EHR data, while diagnosis, disposition, and mentation factors did not. This multicenter data source provides preliminary findings for common geriatric syndromes and conditions. Choice of measures using these data should be driven by GED research questions.
目的
老年急诊科（GED）护理的多中心研究仍然有限。我们的目标是：1. 前瞻性收集由老年急诊护理应用研究（GEAR）网络（一个GED护理的跨学科工作组）确定优先顺序的数据，并创建一个包含前瞻性和电子健康记录（EHR）数据的多中心GED研究储存库；2. 评估前瞻性数据与EHR数据之间的一致性。
方法
GEAR标准化研究（GEARSS）是一项针对老年急诊科（ED）患者（65岁及以上）的多中心前瞻性研究，重点关注老年友好护理的4M（活动能力、用药安全、精神状态、重要事项）和虐待老年人问题。人口统计学和临床数据由经过培训的研究助理（RA）在第0天、第4天、第30天和第90天通过访谈收集，并与EHR相链接。使用描述性统计方法测量并报告慢性合并症的患病率和谵妄发生率。使用科恩kappa系数评估前瞻性数据与EHR数据的一致性。
结果
从3家机构的5个急诊科（2021年3月25日至2022年6月30日）招募了999名参与者：格雷迪健康系统、西北纪念医院和耶鲁纽黑文健康。该队列中女性占57.0%，白人占55.2%，黑人占39.1%，西班牙裔占3.4%，平均年龄为75.1岁。对于风湿性疾病、消化性溃疡疾病、糖尿病、肾脏疾病和癌症，前瞻性数据与EHR数据之间的患病率差异超过10%。约三分之二的参与者有跌倒风险。前瞻性数据与EHR数据在种族方面的一致性良好（K = 0.73）；在性别（K = 1.00）、年龄（K = 1.00）和种族（K = 0.98）方面一致性极佳；在出院处置方面一致性一般（K = 0.53）；在急诊观察状态（K = 0.33）和痴呆症诊断（K = 0.24）方面一致性较弱；在谵妄存在情况方面一致性较差（K = 0.07）。
结论
在GEARSS中，前瞻性数据与EHR数据在人口统计学变量方面高度一致，但在诊断、出院处置和精神状态因素方面不一致。这个多中心数据源为常见的老年综合征和病症提供了初步研究结果。使用这些数据时测量方法的选择应由GED研究问题驱动。
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