Geriatric Emergency Medicine

Primary Researchers

Manish N. Shah, MD, MPH  |  Brian Patterson, MD, MPH  |  Michael Pulia, MD, MS  |  Gwen C. Jacobsohn, PhD, MA  |  Angela Gifford, MA

Goals

The Geriatric Emergency Medicine research program aims to improve health care for older adults with acute illnesses. Many factors limit older adults’ access to safe, patient-centered, efficient, high-quality, acute illness care. These factors lead to poor outcomes, including morbidity, mortality, and unnecessary ED use. Our group is working to identify these factors by developing and testing novel programs to improve the care delivered to acutely ill older adults.

Selected Ongoing Studies

Alzheimer's Disease Research Center Care Research Core

Our Aging Research Group supports innovative research into the pathobiology, early diagnosis, and treatment of Alzheimer’s disease and related illnesses. 

The Care Research Core at the Wisconsin Alzheimer’s Disease Research Center provides novel expertise and resources to conduct innovative studies that will enhance patient care and change clinical practice. It provides guidance and training in multiple aspects of care research, including models of care, caregiver support, end-of-life and palliative care, mobile health technologies, telemedicine, geospatial analytics, and dissemination and implementation research. The Care Research Core at the Wisconsin Alzheimer’s Disease Research Center offers researchers consultations and study design support. If you would like to learn more about care research resources, please complete the Dementia Care Research Core Consultation Form.

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Core Leader: Amy Kind, MD, PhD (Department of Medicine)
Core Co-Leader: Manish Shah, MD, MPH (Department of Emergency Medicine)
Care Research Core Informatics Leader: Andrea Gilmore-Bykovskyi, PhD, RN (School of Nursing)
Care Research Core Small Business Liaison Leader: Nicole Werner, PhD (College of Engineering)
UW Health Physician Informatics and Director for Predictive Analytics: Brian Patterson, MD, MPH (Department of Emergency Medicine)

Engineering Safe Care Journeys for Vulnerable Populations

In this AHRQ-funded study, our team will collaborate with a transdisciplinary team of engineers, health services researchers, nurses, physicians, and pharmacists. We will develop, design, implement, and evaluate a patient safety passport that will support the safe journey of older adults diagnosed with a fall or suspected urinary tract infection in the emergency department. Older adults over 65 are more likely to present to the emergency department and experience patient safety issues after the emergency department visit as compared to younger people. The innovative concept of patient safety passport will be used by patients, caregivers, and clinicians in the emergency department, hospital, and skilled nursing facility, and will facilitate communication and coordination as the patient transitions from the emergency department and travels to the hospital, skilled nursing facility, or home.

GEAR 2.0 – ADC Program: Improving Emergency Care for People with Dementia

Older adults use the emergency department (ED) as an important source of acute medical care, making 20 million visits annually. People with dementia are twice as likely to use the ED and 1.5 times more likely to have an avoidable visit. When in the ED, they often struggle and are at greater risk of poor outcomes; however, little research has studied how to improve emergency care for people with dementia.

The Geriatric Emergency Care Applied Research Network 2.0 – Advancing Dementia Care (GEAR 2.0 ADC) is an NIH funded program to advance the science supporting emergency care for people with dementia. It brings together key stakeholders from emergency medicine, geriatrics, nursing, and social work representing health care systems, clinicians, researchers, caregivers, and, most importantly, people with dementia. Together we will work to identify and prioritize research gaps in emergency care for people who have dementia and support research to improve the care delivered to this vulnerable population.

Dr. Shah is one of two principal investigators awarded a total of $7.5 million from the NIH to conduct this research.

Improving Antibiotic Stewardship for Long-Term Care Facility Residents Treated in the ED

Residents of long-term care facilities (LTCFs) (primarily those > 65 years old with several comorbidities) have been identified as a priority population by the Agency for Healthcare Research and Quality (AHRQ) in part because they are particularly vulnerable to harm related to suboptimal medical care. Each year, over 2.5 million LTCF residents receive care in the ED, often for serious bacterial infections such as pneumonia, urinary tract infections and sepsis. Estimates of inappropriate antibiotic use in this patient population are as high as 75%. Atypical presentations, lack of definitions for infections, and inadequate data exchange during transitions of care may explain the suboptimal antibiotic use observed in this vulnerable population.

The overall objective of this project is to develop an intervention that can improve public health in Wisconsin by reducing inappropriate antibiotic use for LTCF patients in the ED. Given the complex nature of this clinical dilemma, we propose using a mixed methods approach informed by the Systems Engineering Initiative for Patient Safety (SEIPS) framework to identify barriers and facilitators to appropriate antibiotic use for LTCF residents in the ED. This will effectively test our hypothesis that an evidence-based intervention can improve antibiotic for this vulnerable population.

This project was funded by a new investigator grant from the Wisconsin Partnership Program.

Institutional Clinical and Translational Research KL2 Scholar Program

The goal of the UW Institute for Clinical and Translational Research (ICTR) is to create an environment that facilitates the transformation of research at the University of Wisconsin into a continuum extending from investigation through discovery to translation into practice. We aim to provide promising young clinical and translational investigators the training, mentoring, and protected time to develop an independent research program.

The KL2 Scholar Program is funded by the National Institutes of Health through the Clinical and Translational Science Award (CTSA).

Learn more...

Mentoring and Research in Patient-Oriented Geriatric Emergency Care

This NIH-funded study combines mentoring to train the next generation of patient-oriented investigators in geriatric emergency care research, career development in mentoring and implementation science, and research to translate the innovative model of community paramedicine to practice, thereby providing support to community-dwelling patients with Alzheimer’s disease and their caregivers.

Dr. Manish Shah is working to enhance acute illness care for older adults as well as identifying and addressing older adults’ medical and psychosocial needs using community-based paramedics and telemedicine, a model now called community paramedicine.

Paramedic-Coached ED Care Transitions to Help Older Adults Maintain their Health

In this NIH-funded study, the UW Aging Research Group is performing a randomized controlled trial of a new intervention to improve the health of older adults discharged home from the ED. We are adapting the Care Transition Intervention (CTI), a validated hospital-to-home transitions program, to the ED setting and using paramedics to deliver the coaching services. We hypothesize that our CTI program will improve older adults’ post-ED health outcomes, including decreasing the large proportion of older patients that return to an ED for care within 30 days.

Preventing Future Falls Among Older Adults Presenting to the Emergency Department

Older adults rely on the ED for acute, unscheduled care. These visits are an ideal opportunity to screen a high risk population and intervene to prevent downstream morbidity such as falls. Unfortunately, such screening is not routinely performed in the ED setting. In our current AHRQ-funded study, we will utilize existing EHR data sources to improve identification and coordination of care for older adults at high risk for future falls.

In The News

  • Dr. Patterson successfully moves from K08 to R18 funded research with a highly competitive $1.7 million AHRQ grant, of which approximately only 5% of all submissions are funded annually.
  • Gwen Costa Jacobsohn, PhD received the Presidential Best Abstract Award in the Clinical Investigation & Quality Improvement category at the American Geriatrics Society's Virtual Annual Scientific Meeting (AGS 2021) for her abstract, “Design and Implementation of an Automated Fall-Risk Identification and Referral System in the ED."
  • Dr. Patterson invited as a guest lecturer as part of the Department of Medicine, Division of Geriatrics and Geronotlogy's Health Science and Care Research Program seminar series. The title of his seminar, "Development of an Automated Screening and Referral Intervention to Prevent Falls Among Older Adults Presenting to the Emergency Department," was presented on June 14, 2021.
  • Dr. Shah receives 2021 Academic Career Achievement Award from the Academy of Geriatric Emergency Medicine for his significant contributions to improving geriatric emergency care through clinical and translational research.
  • Aging Research Group presents at 2021 national meetings for the Society for Academic Emergency Medicine and the American Geriatrics Society. Read more...
  • The BerbeeWalsh Department of Emergency Medicine ranked among the top 20 departments in the nation for research funds awarded in emergency medicine by the National Institutes of Health (NIH) in 2020. Dr. Manish Shah was also ranked among the top emergency medicine researchers. A major focus of his research efforts in 2021 and beyond is the GEAR 2.0 – ADC effort funded by the NIH, which aims to improve care in EDs for people with dementia.

View additional research program highlights...

Funding

Geriatric Emergency Care Applied Research Network 2.0 – Advancing Dementia Care (GEAR 2.0 ADC)
Source: National Institute on Aging - NIH
Faculty: Manish Shah, MD, MPH
Total Award: $7.5 million

Alzheimer's Disease Research Center: Care Research Core
Source: National Institutes of Health (NIH)
Type: P30
Faculty: Manish Shah, MD, MPH; Brian Patterson, MD, MPH

Engineering Safe Care Journeys for Vulnerable Populations
Source: Agency for Healthcare Research and Quality (AHRQ)
Type: R18
Faculty: Manish Shah, MD, MPH; Brian Patterson, MD, MPH; Michael Pulia, MD, MS; Azita Hamedani, MD, MPH, MBA

The Institutional Clinical and Translational Sciences Award
Source: National Center for Advancing Translational Sciences - NIH
Type: KL2
Faculty: Manish Shah, MD, MPH

Mentoring and Research in Patient-Oriented Geriatric Emergency Care: The Role of Unmet Medical and Psychosocial Needs on Acute Care Use by Patients with Dementia
Source: National Institute on Aging - NIH
Type: K24
Faculty: Manish Shah, MD, MPH

Preventing Future Falls Among Older Adults Presenting to the Emergency Department
Source: Agency for Healthcare Research and Quality (AHRQ)
Type: K08
Faculty: Brian Patterson, MD, MPH

Paramedic-Coached ED Care Transitions to Help Older Adults Maintain their Health
Source: National Institute on Aging - NIH
Type: R01
Faculty: Manish Shah, MD, MPH

Podcasts

Dementia Matters podcastEmergency Care Tips for People with Dementia
Dementia Matters podcast | 28 January 2021
Listen now

Visiting the emergency department can be a challenging experience for individuals with memory loss and their caregivers. Dr. Manish Shah joins the podcast to discuss the difficulties people with dementia face in the emergency department and offers tips for making the most out of a visit.

Telemedicine Reduces Emergency Room Visits for Dementia Patients
Dementia Matters podcast | 30 July 2019
Listen now

A visit to the Emergency Department can be stressful and disorienting for a person with dementia, and oftentimes unnecessary. Dr. Manish Shah discusses his research into programs that reduce Emergency Room visits for dementia patients.

Publications

For publications, please see:

Manish Shah, MD, MPH Google Scholar Profile
Brian Patterson, MD, MPH Google Scholar Profile
Michael Pulia, MD, MS Google Scholar Profile
Gwen Jacobsohn, PhD Google Scholar Profile