6. ABSTRACT Principal Investigator: Lori A. Post, Ph.D. Associate Professor, Yale Dept of Emergency Medicine Title: ED Disability Diagnostic Tool: an HIT Feasibility Study Objective: To improve health patient oriented outcomes in Emergency Departments (ED) by deriving, validating, and comparing the Rasch Disability Diagnostic Tool (RDDT) to existing Measure of Disability (MOD) Research Design: This multi methodological study includes deriving a Rasch scale of disability: I) Using the RDDT to retrospectively score disability indicators, validating the RDDT, selecting a subset of the Rasch scale to be used as a brief measure for an ED randomized clinical trial;II) Prospectively, linking disability assessments to patient oriented outcomes (health care service utilization and mortality). This study will compare diagnoses to determine impact on patient outcomes and costs. Methodology: An expert panel will determine content for the disability diagnostic tool, Rasch scales will be created to score disability in existing hospital records in the retrospective phase. First, we will retrieve all disability assessments performed on ED patients (20-30 per day) since the inception of the electronic data collection system at Yale New Haven Hospital (April 2005). Second, we will score disability in ED records for patients >65 years and examine patient outcomes, treatments and referrals based on the assessment. Third, we will examine how the assessment impacted ED patient oriented outcomes. The retrospective phase of this study will allow us to track subsequent Yale hospital and ED visits, treatments, and health outcomes. A brief accurate and precise RDDT, developed in the retrospective analysis will be used for the prospective phase to compare with the existing MOD in a randomized clinical trial. 600 patients will be recruited over the course of the study and randomly allocated into the MOD (control) or RDDT (test) arm. Consented study subjects, including ED patients, families, and patient health care providers will be followed for two months. The primary patient outcomes, ED visits, hospital admits, and mortality will be quantified for comparative purposes. We will estimate the number of preventable ED visits and hospitalizations and provide a cost benefit for adopting the RDDT in EDs. Finally, the RDDT will rely on health information technology. The exploratory aim of the study will assess work flow, time and cost savings, efficiency and usability for use in the ED. Potential Impact on Health Outcomes: We expect that a better disability diagnostic tool will lead to lower mortality, a reduction in unnecessary costs, preventable ED visits and hospitalizations, and a better quality of life for patients presenting to Emergency Departments.

Public Health Relevance

Increasing numbers of elderly and/or disabled persons are presenting to Emergency Departments (ED) that require an assessment of their disabilities for treatment and proper referral. ED physicians are often at a loss because these patients do not require acute care or hospitalization yet their failure to thrive in the community brings them repeatedly to the ED where their needs are not being met. This study aims to improve health outcomes of persons presenting to EDs by developing and validating a disability diagnostic tool which will allow ED physicians to connect these patients to better health care referrals, proper long term care services and other non ED health care providers.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
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Health Care Technology and Decision Science (HTDS)
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Nunley, Angela
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Yale University
Emergency Medicine
Schools of Medicine
New Haven
United States
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