Speaker
Corita R. Grudzen, MD, MSHS, FACEP
Professor, Emergency Medicine and Population Health
Associate Dean, Clinical Sciences
Deputy Director, Clinical and Translational Science Institute
Vice Chair for Research, Emergency Medicine
Ronald O. Perelman Department of Emergency Medicine
NYU Grossman School of Medicine
Keywords
Palliative Care; Stepped-Wedge study design; Emergency Department (ED); Gagne Index; PRIM-ER
Key Points
- The Emergency Department is increasingly seeing older adults with serious illness rather than patients with acute trauma.
- Primary Palliative Care for Emergency Medicine (PRIM-ER) is a stepped-wedge study partnership of 18 health systems in 33 EDs designed to change the culture and norms of emergency care to promote palliative care at home or hospice rather than admittance to the hospital.
- The study used the Gagne Index greater than 6 to identify patients at high risk of short-term mortality. Patients with dementia did not need to meet the Gagne Index criteria to be included in the study.
- A baseline survey, training of 2,470 emergency providers, and study intervention has been completed at all 33 sites.
- Only .2% of ED patients in the study were admitted to hospice after their ED visit. At 12 months post ED visit, 30% of dementia patients had died whereas 15.6% of the non-dementia chronic disease patients had died. Data analysis is ongoing.
Discussion Themes
Stepped-wedge studies present timing issues and COVID-19 increased these problems. A cluster randomized design may have been easier to implement.
The PRIM-ER study was considered quality improvement by the IRB, so no human subjects approval from the IRB was required.
The PRIM-ER next step will be developing tools for patients with dementia regarding palliative care in the ED.
Learn more about the PRIM-ER study.
Tags
#pctGR, @Collaboratory1