Kelly J. Ko, PhD

While significant progress has been made in developing regional health information exchange and the focus shifts to national exchanges, we highlight 3 key lessons from prior experience. First, we must include the entire continuum of care, including post-acute. Second for exchanges to be successful local regions and states must take a vested interest in their progress, and finally we must maintain standards to prevent fragmented exchanges.

While the role of data in healthcare has no doubt been growing in recent years, one area that has remained elusive is information sharing, otherwise known as interoperability. In this article we discuss interoperability as it stands today, as well as implications impacting business decisions, including privacy and commercial strategy.

The global pandemic has raised awareness of the need for telehealth. Prior to this study, research has been mixed on its effectiveness and impact on downstream utilization, especially for seniors. We conducted a retrospective cohort study of three different models of telehealth from three health systems, comparing them to in-person visits for urgent and non-emergent needs of seniors. Telehealth encounters were successful in resolving urgent and non-emergent needs in 84.0–86.7% of cases. When… Show more

The global pandemic has raised awareness of the need for telehealth. Prior to this study, research has been mixed on its effectiveness and impact on downstream utilization, especially for seniors. We conducted a retrospective cohort study of three different models of telehealth from three health systems, comparing them to in-person visits for urgent and non-emergent needs of seniors. Telehealth encounters were successful in resolving urgent and non-emergent needs in 84.0–86.7% of cases. When visits required follow-up, over 95% were resolved in less than three visits for both telehealth and in-person cohorts. When deployed within the confines of a patient’s existing primary care and health system provider, telehealth can be an effective alternative to in-person care for urgent and non-emergent needs of seniors without increasing downstream utilization. Show less

Older adult delirium is often unrecognized in the Emergency Department (ED), the Geriatric Emergency care Applied Research (GEAR) Network sought to identify and prioritize delirium clinical questions. GEAR engaged 49 transdisciplinary stakeholders conducted a comprehensive scoping review and a consensus conference to identify high priority areas for research. Overall, clinical gestalt was the most common method to detect delirium and 3 medications were commonly used to reduce or prevent ED… Show more

Older adult delirium is often unrecognized in the Emergency Department (ED), the Geriatric Emergency care Applied Research (GEAR) Network sought to identify and prioritize delirium clinical questions. GEAR engaged 49 transdisciplinary stakeholders conducted a comprehensive scoping review and a consensus conference to identify high priority areas for research. Overall, clinical gestalt was the most common method to detect delirium and 3 medications were commonly used to reduce or prevent ED delirium. After review, we identified prevention as the highest priority for research, specifically defining etiologic phenotypes to target prevention or intervention strategies. Show less

Overdiagnosis of urinary tract infections (UTI) among people living with dementia is a nationally recognized problem associated with morbidity from antibiotics as well as multidrug‐resistant bacteria. In our model, people living with dementia had over twice the odds of being diagnosed with a UTI in the ED compared to those without dementia despite lower prevalence of symptoms and signs localizing to the genitourinary tract. This is the first study from a national database examining the… Show more

Overdiagnosis of urinary tract infections (UTI) among people living with dementia is a nationally recognized problem associated with morbidity from antibiotics as well as multidrug‐resistant bacteria. In our model, people living with dementia had over twice the odds of being diagnosed with a UTI in the ED compared to those without dementia despite lower prevalence of symptoms and signs localizing to the genitourinary tract. This is the first study from a national database examining the association of dementia with UTI diagnosis among older adults visiting the ED and points toward the disproportionate burden of UTI diagnoses in people living with dementia despite lower prevalence of clinical criterion. Show less

Ambulatory‐care‐sensitive conditions (ACSCs) represent emergency department (ED) visits and hospital admissions that might have been avoided through earlier primary care intervention. We characterize the current frequency and cost of ACSCs among older adults (≥65 years of age) in the ED.

COVID-19 has led to a dramatic increase in the use of telehealth and Emergency Departments (EDs) around the country are leveraging telehealth as a tool in a variety of settings. We outline 3 models illustrating how telehealth is being used to increase access and care for older adults. In each model we emphasize needs of unique populations, example workflows, and staffing considerations. Addressing the healthcare needs of vulnerable seniors by virtual connection minimizes exposure to infection… Show more

COVID-19 has led to a dramatic increase in the use of telehealth and Emergency Departments (EDs) around the country are leveraging telehealth as a tool in a variety of settings. We outline 3 models illustrating how telehealth is being used to increase access and care for older adults. In each model we emphasize needs of unique populations, example workflows, and staffing considerations. Addressing the healthcare needs of vulnerable seniors by virtual connection minimizes exposure to infection for patients and providers, positioning telehealth as a critical tool during the pandemic. Show less

We discuss the increasingly key role of Emergency Departments around the country in treating older adults, and how the advent of Geriatric Emergency Departments (GED)means better care for this age cohort. Evidence for this young and growing field is still building, however GEDs are put forward as important components of age-friendly health systems as well as catalysts in the shift toward value-based healthcare.

Published literature on national emergency department (ED) revisit rates among older adults with dementia is sparse, despite anecdotal evidence of higher ED utilization. We assessed 30‐day ED revisit rates among Medicare beneficiaries with and without dementia diagnosis before or at index ED visit. Dementia was associated with markedly higher revisit rates, pointing towards opportunities to manage and transition dementia patients from the ED back to the community more effectively.

This practical guide covers a range of topics in detail to help you understand the specifics of the technology’s use, the broader landscape of telehealth, and how you can tailor these innovations to your organization’s requirements. From needs and readiness assessments to reimbursement models and performance monitoring, we have created a comprehensive guide for effective telehealth program implementation for PALTC.

Frequent users of the emergency department (ED) are often associated with increased costs, however limited research is devoted to geriatric frequent users of the ED which is not only growing at a rapid rate, but also accounts for the highest use of health care resources. Our multicenter study found geriatric frequent users are likely to have comorbid conditions, notably diabetes, and be treated for conditions related to pain and injuries

Falls is one of the leading causes of visits to the ED among older adults. We analyzed national claims data to determine if physical therapy (PT) in the ED was associated with reduced likelihood of ED return visits for falls. Our results demonstrate that offering PT services in the ED was significantly associated with reduced likelihood of return falls. Expanding PT services in the ED may reduce future fall-related ED use of older adults.

To support health systems developing a geriatric emergency department (GED) in their own facility, UC San Diego Health and the West Health Institute created this implementation guide based on our experience establishing the Gary and Mary West Senior Emergency Care Unit (SECU) within the Gary and Mary West Emergency Department at UC San Diego Health in La Jolla.

Although the potential for telehealth has been touted for years, adoption remains limited, with one of the most likely reasons being inconsistent measurement and an emphasis on modality. We propose shifting measurement away from the delivery model and instead focusing on overall health impact, which may also be more applicable in a value-based environment.

There is abundant evidence that an ED visit signifies a period of vulnerability for older
adults, and the transition between the ED and community can be fraught with
challenges. This article describes some challenges of care transitions, reviews best practice strategies, provides an example of systems-based improvements that have been implemented, and outlines key lessons learned.

Delirium is common among seniors discharged from the emergency department (ED) and associated with increased risk of mortality. Prior research has addressed this issue, however has generally relied on data from a single institution or single time points. In our study we leveraged claims data to address mortality risk up to 12 months. Our findings indicate delirium is a significant marker of mortality and risk is most salient in the first 3 months following an ED visit, pointing to the need for… Show more

Delirium is common among seniors discharged from the emergency department (ED) and associated with increased risk of mortality. Prior research has addressed this issue, however has generally relied on data from a single institution or single time points. In our study we leveraged claims data to address mortality risk up to 12 months. Our findings indicate delirium is a significant marker of mortality and risk is most salient in the first 3 months following an ED visit, pointing to the need for increased delirium screening and management within the ED. Show less

The senior population is the fastest growing segment of our population, calling for increased attention to their healthcare needs, notably in the Emergency Department. We describes the growing field of Geriatric Emergency Medicine, including recent advances in innovation, collaboration, and next steps to serve the growing needs of the geriatric patient population.

Population health management strategies can change the way clinical care reaches patients and likely influence clinical research. To understand this shift, we conducted a systematic literature review, administered an electronic survey, and facilitated an expert panel meeting. Our findings suggest a population health framework will indeed impact clinical trials, however, instead of widespread change, clinical trials will advance in a piecemeal fashion, with new approaches implemented only under… Show more

Population health management strategies can change the way clinical care reaches patients and likely influence clinical research. To understand this shift, we conducted a systematic literature review, administered an electronic survey, and facilitated an expert panel meeting. Our findings suggest a population health framework will indeed impact clinical trials, however, instead of widespread change, clinical trials will advance in a piecemeal fashion, with new approaches implemented only under the right circumstances; for specific study outcomes, therapeutic areas, and target populations. Show less

Describe implementation of an integrated clinical research data repository through the secondary use of electronic health record data to promote data-driven and clinical and translational resarch. Furthermore, we developed a trustworthy access-management protocol for providing access to both clinically relevant and protected health information.

Care transitions between settings are a well-known cause of medical errors. A key component of transition is information exchange, especially in long-term care (LTC). However, LTC is behind in adoption of health information technologies (HIT). We describe a pilot project using HIT in LTC to facilitate electronic information exchange during care transitions. We found inpatient readmission and return emergency department (ED) visit rates were lower than baseline following implementation. We offer… Show more

Care transitions between settings are a well-known cause of medical errors. A key component of transition is information exchange, especially in long-term care (LTC). However, LTC is behind in adoption of health information technologies (HIT). We describe a pilot project using HIT in LTC to facilitate electronic information exchange during care transitions. We found inpatient readmission and return emergency department (ED) visit rates were lower than baseline following implementation. We offer implications for practice and research for information exchange across settings. Show less

Describe issues related to lack of patient enrollment in clinical research and the role of provider engagement. We conducted a survey of providers at a large health system describing the gap between active research studies and provider awareness of research opportunities. Increased provider awareness coupled with education and technology making this information available at the point of care may help increase patient enrollment.

Explore issues/barriers related to implementation of a pharmacy-based adult vaccine benefit. Our findings suggest employers play a key role in requesting such changes, however, lack of consistent communication between pharmacists and primary care providers remains a barrier. In order to address this issue, pharmacists must be viewed within the broader context of preventative care.

Sponsors of clinical research are required to monitor the conduct and progress of clinical studies to ensure protection of human subjects and integrity of data submitted to the FDA. However, the manner in which studies are monitored varies widely and often includes onsite visits disrupting workflow and are costly. We propose a mixed approach of onsite as well as remote monitoring techniques based on risk assessment for individual studies.

Our goal was to develop and test a structured approach to evidence evaluation in formulary decision-making. Although survey results indicated a structured approach would yield additional clarity, consistency, and transparency in the decision-making process, pilot testing in a real-world P&T committee highlighted some of the limitations of a structured approach.

In this cohort of hospitalized patients, analogue bolus insulin was associated with lower mortality, shorter LOS, and modestly better BG control compared with patients treated with human bolus insulin. These results highlight the need for a randomized controlled clinical trial comparing outcomes by bolus insulin type in the hospital setting to determine a true mortality benefit.

This study examined whether perceived coping effectiveness was associated with better diabetes management and was higher when adolescent coping was matched with parents stress appraisal. Higher perceived coping effectiveness was associated with fewer depressive symptoms, self-care behaviors, and better metabolic control, especially when adolescents and parents appraised stress similarly.

Spouses were substantially similar in the pattern of aging profiles. Profiles of successful aging discriminated on external measures of well-being such as cognition, physical health, and social support. However, older adults were not always associated with less favorable profiles of aging. The results point to the value of a multidimensional perspective of successful aging in couples across the life span.