Despite nearly 1.4 million emergency department (ED) visits annually among patients with Alzheimer’s disease and related dementias, many of their clinical and social needs remain unmet, resulting in return visits to the ED.
In a new five-year, $54.9 million study funded by a U19 award from the NIH, faculty leaders at NYU Langone Health will examine how to improve emergency and post-discharge care for those living with dementia and their care partners.
NYU Langone was chosen as one of the lead sites for the study—dubbed ED-LEAD, or Emergency Departments Leading the Transformation of Alzheimer’s and Dementia Care—and will be responsible for coordinating and implementing the research activities of 82 participating sites nationwide.
“Even with advances in geriatric emergency care, the ED is a suboptimal setting for this population, who often require care for multiple chronic conditions,” says Joshua Chodosh, MD, director of the Division of Geriatric Medicine and Palliative Care.
Dr. Chodosh will co-lead the project with three other principal investigators, Abraham A. Brody, PhD, of NYU Langone, and national colleagues Corita R. Grudzen, MD, at Memorial Sloan Kettering Cancer Center, and Manish N. Shah, MD, at the University of Wisconsin–Madison.
Addressing Unmet Needs
According to Dr. Chodosh, the symptoms of dementia place older adults at increased risk of requiring hospital and acute care services, often resulting in costly and under-reimbursed care. To reduce the overreliance on emergency care, researchers seek to test three different strategies to provide best care for persons living with dementia and their family care partners.
Dr. Chodosh and his colleagues believe that many of these acute care visits could be avoided, maintaining that care could be provided in better-resourced settings.
“These patients incur higher costs, are admitted to hospitals more often, return to EDs more frequently, and have higher mortality after an ED visit compared to those without dementia.”
Joshua Chodosh, MD
“We lack data on long-term clinical outcomes of patients with dementia who seek care in the ED,” he says. “These patients incur higher costs, are admitted to hospitals more often, return to EDs more frequently, and have higher mortality after an ED visit compared to those without dementia.”
Examining Three Distinct Interventions
For the study, interdisciplinary teams from all participating sites will evaluate different combinations of three interventions focused on care partners: Emergency Care Redesign (ECR), Nurse-Led Telephonic Care (NLTC), and Community Paramedic-Led Transitions Intervention (CPTI).
With respect to outcomes, the effectiveness of these interventions on ED revisits, hospitalizations, and healthy days at home will be evaluated at specific time intervals—14 days, 30 days, and 6 months—post-discharge.
Across the clinical sites, Dr. Chodosh will be implementing the ECR intervention, designed to optimize the workflow of emergency providers with digital alerts and structured collaborations with external partners. This intervention is specifically designed for those with dementia who live on their own in the community.
“Our aim with this intervention is to redesign workflows from when patients first present to their discharge back into the community,” he explains.
The NTLC intervention, directed by Dr. Brody, will provide psychosocial support and connect patients and their care partners to community support and services. The CPTI, led by Dr. Shah, will provide a coaching intervention delivered by community paramedics to empower patients and care partners to manage their healthcare with confidence. All three programs hope to reduce future ED visits and hospitalizations while improving transitional care, quality of care, and care satisfaction, Dr. Chodosh says.
Laying the Groundwork for Change
Given the size and scope of the project, the investigators believe that it provides a prime opportunity to establish best practices and optimize workflows for geriatric emergency and post-emergency care at a national level.
“We hope that one or a combination of these interventions will reduce unnecessary ED visits and hospitalizations for this population.”
Additionally, these interventions could be used to reduce costs for health systems.
“We hope that one or a combination of these interventions will reduce unnecessary ED visits and hospitalizations for this population,” Dr. Chodosh says. “Health systems may then better allocate scarce resources to where they can be best used.”
