This application proposes a mentoring and training program for Dr. Ula Hwang in patient-oriented aging research in the emergency department (ED). The long-term career goals of Dr. Hwang are to become an independent investigator with a focus on understanding and improving pain management for older adults seen in the ED. The evaluation of factors (both patient-related characteristics and environmental conditions in the ED) associated with poorer pain care will allow Dr. Hwang to develop and target future interventions to improve pain management for older adults. This award will provide her with the data, training, experience, and credibility to become an advocate and leader for promoting better quality of care for older adults in the ED. This application details a five-year plan that includes extensive mentoring, research training, geriatrics education activities, and two research projects - all building upon Dr. Hwang's previous training and current research. Under the mentorship of leaders in both the fields of geriatrics (Dr. R. Sean Morrison, primary mentor) and emergency medicine (Dr. Lynne D. Richardson), she will receive strong guidance throughout the award period in the areas of methodology, aging research, and elder care in the ED. She will be additionally supported by a content mentor in emergency pain research (Dr. Knox Todd) and a statistical mentor (Dr. Gary Winkel). Formal coursework will strengthen her foundation in biostastitical methods using large data sets, utilizing time data and hierarchical models, and focusing on outcomes and statistical principles specific to the older adult. A geriatrics educational curriculum tailored for Dr. Hwang by her educational mentor (Dr. Roseanne Leipzig) will allow her to expand her knowledge and understanding of aging research, providing her with a Geriatrician's perspective on ED care for older adults and Geriatric-Emergency Medicine research. The two proposed studies of the application complement each other, while building and expanding on previous work by Dr. Hwang.
The specific aims of Project One are to study how patient-related characteristics and ED crowding factors affect pain care for older adults, while Project Two will examine short-term clinical outcomes associated with ED pain care. Both projects involve collaborations with existing research groups. Project One involves a collaboration with a multicenter consortium of academic EDs studying crowding, while Project Two uses data from a prospective multicenter observational study of palliative care outcomes for hospitalized cancer patients. The results of both projects will permit the testing of several hypotheses related to ED pain management for older adults and its outcomes. These results will also provide the foundation from which major studies evaluating pain care interventions may be designed and targeted for the older adult. Pain care is a model condition for evaluating the quality of care. Investigating how pain care delivery for the older adult in the ED setting is affected by patient-related and ED environmental factors, and understanding the relevance of ED pain care in the continuum of hospital care can make an important contribution to preparing the ED, and the healthcare system in general, to focus on the challenges of providing high quality geriatric patient care.
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