210EMF Changes in Health-Related Quality of Life for Geriatric Patients After an Emergency Department Visit

Abstract

The Geriatric Emergency Department Innovations (GEDI) program has decreased hospitalizations. The impact on health-related quality of life (HRQoL) are unknown. The objective of this study is to evaluate the impact of GEDI on overall self-reported health and priority domains of HRQoL including physical function, anxiety, depression, and the ability to participate in social roles and activities. We performed a prospective cohort study comparing GEDI patients to control patients. All patients age 65+ were eligible. Patients were excluded if they were non-English speaking, or if they had altered mental status as measured by the six-item screener. Eligible patients provided informed consent while in the ED. Patients were enrolled from 3/2015-8/2015 and from 1/2017 to present. Enrolled patients completed a series of patient reported outcomes measures in the ED using Patient Reported Outcomes Measures Information System (PROMIS). Clinical data were obtained through the Enterprise Data Warehouse. Follow-up measures were performed at 10 days, 4 weeks, and 8 weeks. Follow-up was performed via phone or email per patient’s choice. In this preliminary report, we analyze data from the baseline instruments and 10-day follow-up. Data were recorded in REDCap. Categorical variables were evaluated using chi squared test. Continuous variables were evaluated using Student’s t test. Of the 415 patients approached, 219 provided consent, and 210 completed the baseline measures. There were significant differences between the GEDI and the control groups in age, race, baseline physical function, and baseline depression (Table 1). Compared to national population data across age groups, baseline PROMIS measures indicated that patients in the GEDI group were at the 36th percentile in physical function, 41st percentile for satisfaction with social roles, 53rd percentile for anxiety, and 53rd percentile for depression. Patients in the control group were at the 40th percentile for physical function, 42nd percentile for satisfaction with social roles, 51st percentile for anxiety, and 49th percentile for depression. At 10 days’ post ED visit, compared to control patients, GEDI patients were less likely to say their overall health was much worse (5.1% vs 23.9%), and more likely to report it as unchanged (35.9% vs 18.2%) (p=0.03). Compared to control patients there was no significant difference in change of any PROMIS measures at 10 days post ED visit: physical function -2.7 points for GEDI -1.1 points for controls (p=0.28), satisfaction with social roles -3.0 points for GEDI -1.4 points for controls (p=0.43), anxiety -2.1 for GEDI -0.8 for controls (p=0.29), depression -0.6 points for GEDI +0.4 points for controls (p=0.34). In this preliminary analysis, we have found that geriatric patients in the ED have lower HRQoL related to physical function and social roles than the general population, but nearly average HRQoL for anxiety and depression. At 10 days post ED visit compared to control patients GEDI patients are less likely to report their health as much worse and more likely to report it as unchanged from baseline taken in the ED. However, significant differences between changes in PROMIS measures were not yet observed.