1
|
Yao P, Gogia K, Clark S, Hsu H, Sharma R, Greenwald P. Differences in antibiotic prescriptions between direct-to-consumer telehealth and telehealth in the emergency department. J Telemed Telecare 2024; 30:151-155. [PMID: 34515560 DOI: 10.1177/1357633x211034994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Telemedicine, which allows physicians to assess and treat patients via real-time audiovisual conferencing, is a rapidly growing modality for providing medical care. Antibiotic stewardship is one important measure of care quality, and research on antibiotic prescribing for acute respiratory infections in direct-to-consumer telemedicine has yielded mixed results. We compared antibiotic prescription rates for acute respiratory infections in two groups treated by telemedicine: (1) patients treated via a direct-to-consumer telemedicine application and (2) patients treated via telemedicine while physically inside the emergency department. METHODS We included direct-to-consumer telemedicine and emergency department telemedicine visits for patients 18 years and older with physician-coded International Classification of Diseases, Tenth Revision acute respiratory infection diagnoses between November 2016 and December 2018. Patients in both groups were seen by the same emergency department faculty working dedicated telemedicine shifts. We compared antibiotic prescribing rates for direct-to-consumer telemedicine and emergency department telemedicine visits before and after adjustment for age, sex, and diagnosis. RESULTS We identified a total of 468 acute respiratory infection visits: 191 direct-to-consumer telemedicine visits and 277 emergency department telemedicine visits. Overall, antibiotics were prescribed for 47% of visits (59% of direct-to-consumer telemedicine visits vs 39% of emergency department telemedicine visits; odds ratio 2.23; 95% confidence interval 1.53-3.25; P < 0.001). The difference in antibiotic prescribing rates remained significant after adjustment for age, sex, and diagnosis (odds ratio 2.49; 95% confidence interval 1.65-3.77; P < 0.001). CONCLUSION Patients seen by the same group of physicians for acute respiratory infection were significantly more likely to be prescribed antibiotics by direct-to-consumer telemedicine care compared with telemedicine care in the emergency department. This work suggests that contextual factors rather than evaluation over video may contribute to differences in antibiotic stewardship for direct-to-consumer telemedicine encounters.
Collapse
Affiliation(s)
- Peter Yao
- Weill Cornell Medical College, New York, NY, USA
| | - Kriti Gogia
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Hanson Hsu
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Rahul Sharma
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Peter Greenwald
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
2
|
Rosen T, Rippon B, Elman A, Gogia K, Chansakul A, Chang ES, Hancock DW, Bloemen EM, Clark S, LoFaso VM. Mechanisms and weapons in physical elder abuse injuries: Findings from legally adjudicated cases. Injury 2023; 54:110845. [PMID: 37296012 PMCID: PMC10527085 DOI: 10.1016/j.injury.2023.110845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Elder abuse is common, but many characteristics have not been well-described, including injury mechanisms and weapons in physical abuse. Better understanding of these may improve identification of elder abuse among purportedly unintentional injuries. Our goal was to describe mechanisms of injury and weapons used and their relation to injury patterns. METHODS We partnered with District Attorney's offices in 3 counties and systematically examined medical, police, and legal records from 164 successfully prosecuted physical abuse cases of victims aged ≥60 from 2001 to 2014. RESULTS Victims sustained 680 injuries (mean 4.1, median 2.0, range 1-35). Most common mechanisms were: blunt assault with hand/fist (44.5%), push/shove, fall during altercation (27.4%), and blunt assault with object (15.2%). Perpetrators more commonly used body parts as weapons (72.6%) than objects (23.8%). Most commonly used body parts were: open hands (55.5% of victims sustaining injuries from body parts), closed fists (53.8%), and feet (16.0%). Most commonly used objects were: knives (35.9% of victims sustaining injuries from objects) and telephones (10.3%). The most frequent mechanism/injury location pair was maxillofacial/dental/neck injury by blunt assault with hand/fist (20.0% of all injuries). The most frequent mechanism/injury type pair was bruising by blunt assault with hand/fist (15.1% of all injuries). Blunt assault with hand/fist injury was positively associated with victim female sex (OR: 2.27, CI: [1.08 - 4.95]; p = 0.031), while blunt assault with object mechanisms was inversely associated with victim female sex (OR: 0.32, CI: [0.12 - 0.81]; p = 0.017). CONCLUSION Physical elder abuse victims are more commonly assaulted with an abuser's body part than an object, and the mechanisms and weapons used impact patterns of injury.
Collapse
Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, Room M130, New York, NY, 10065, USA.
| | - Brady Rippon
- Department of Population Health Sciences, Weill Cornell Medicine, 402 E 67th Street, New York, NY, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, Room M130, New York, NY, 10065, USA
| | - Kriti Gogia
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, Room M130, New York, NY, 10065, USA
| | - Aisara Chansakul
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, Room M130, New York, NY, 10065, USA
| | - E-Shien Chang
- Division of Geriatrics and Palliative Medicine, 525 East 68th Street, Baker 14, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - David W Hancock
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, Room M130, New York, NY, 10065, USA
| | - Elizabeth M Bloemen
- Division of Geriatric Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO, 80045, USA
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, Room M130, New York, NY, 10065, USA
| | - Veronica M LoFaso
- Division of Geriatrics and Palliative Medicine, 525 East 68th Street, Baker 14, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| |
Collapse
|
3
|
Rosen T, Elman A, Clark S, Gogia K, Stern ME, Mulcare MR, Makaroun LK, Gottesman E, Baek D, Pearman M, Sullivan M, Brissenden K, Shaw A, Bloemen EM, LoFaso VM, Breckman R, Pillemer K, Sharma R, Lachs MS. Vulnerable Elder Protection Team: Initial experience of an emergency department-based interdisciplinary elder abuse program. J Am Geriatr Soc 2022; 70:3260-3272. [PMID: 35860986 PMCID: PMC9669128 DOI: 10.1111/jgs.17967] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/07/2022] [Accepted: 05/27/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND An emergency department (ED) visit provides a unique opportunity to identify elder abuse and initiate intervention, but emergency providers rarely do. To address this, we developed the Vulnerable Elder Protection Team (VEPT), an ED-based interdisciplinary consultation service. We describe our initial experience in the first two years after the program launch. METHODS We launched VEPT in a large, urban, academic ED/hospital. From 4/3/17 to 4/2/19, we tracked VEPT activations, including patient characteristics, assessment, and interventions. We compared VEPT activations to frequency of elder abuse identification in the ED before VEPT launch. We examined outcomes for patients evaluated by VEPT, including change in living situation at discharge. We assessed ED providers' experiences with VEPT via written surveys and focus groups. RESULTS During the program's initial two years, VEPT was activated and provided consultation/care to 200 ED patients. Cases included physical abuse (59%), neglect (56%), financial exploitation (32%), verbal/emotional/psychological abuse (25%), and sexual abuse (2%). Sixty-two percent of patients assessed were determined by VEPT to have high or moderate suspicion for elder abuse. Seventy-five percent of these patients had a change in living/housing situation or were discharged with new or additional home services, with 14% discharged to an elder abuse shelter, 39% to a different living/housing situation, and 22% with new or additional home services. ED providers reported that VEPT made them more likely to consider/assess for elder abuse and recognized the value of the expertise and guidance VEPT provided. Ninety-four percent reported believing that there is merit in establishing a VEPT Program in other EDs. CONCLUSION VEPT was frequently activated and many patients were discharged with changes in living situation and/or additional home services, which may improve safety. Future research is needed to examine longer-term outcomes.
Collapse
Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Sunday Clark
- Department of Surgery, Boston University School of Medicine / Boston Medical Center, Boston, MA, USA
| | - Kriti Gogia
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Michael E. Stern
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Mary R. Mulcare
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Lena K. Makaroun
- Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- VA Pittsburgh Healthcare System Center for Health Equity Research and Promotion, Pittsburgh, PA, USA
| | - Elaine Gottesman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Daniel Baek
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Morgan Pearman
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Michelle Sullivan
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Kelly Brissenden
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Amy Shaw
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Elizabeth M. Bloemen
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Veronica M. LoFaso
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Risa Breckman
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| | - Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, NY, USA
| | - Rahul Sharma
- Department of Emergency Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Mark S. Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College / NewYork-Presbyterian Hospital, New York, NY, USA
| |
Collapse
|
4
|
Lachs DK, Stern ME, Elman A, Gogia K, Clark S, Mulcare MR, Greenway A, Golden D, Sharma R, Bessey PQ, Rosen T. Geriatric Burn Injuries Presenting to the Emergency Department of a Major Burn Center: Clinical Characteristics and Outcomes. J Emerg Med 2022; 63:143-158. [PMID: 35637048 PMCID: PMC9489596 DOI: 10.1016/j.jemermed.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 01/05/2022] [Accepted: 01/25/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Burn injuries in geriatric patients are common and may have significant associated morbidity and mortality. Most research has focused on the care of hospitalized patients after admission to burn units. Little is known about the clinical characteristics of geriatric burn victims who present to the emergency department (ED) and their ED assessment and management. OBJECTIVE Our aim was to describe the clinical characteristics and outcomes of geriatric patients presenting to the ED with burn injuries. METHODS We performed a comprehensive retrospective chart review on all patients 60 years and older with a burn injury presenting from January 2011 through September 2015 to a large, urban, academic ED in a hospital with a 20-bed burn center. RESULTS A total of 459 patients 60 years and older were treated for burn injuries during the study period. Median age of burn patients was 71 years, 23.7% were 80 years and older, and 56.6% were female. The most common burn types were hot water scalds (43.6%) and flame burns (23.1%). Median burn size was 3% total body surface area (TBSA), 17.1% had burns > 10% TBSA, and 7.8% of patients had inhalation injuries. After initial evaluation, 46.4% of patients were discharged from the ED. Among patients discharged from the ED, only 1.9% were re-admitted for any reason within 30 days. Of the patients intubated in the ED, 7.1% were extubated during the first 2 days of admission, and 64.3% contracted ventilator-associated pneumonia. CONCLUSIONS Better understanding of ED care for geriatric burn injuries may identify areas in which to improve emergency care for these vulnerable patients.
Collapse
Affiliation(s)
- David K Lachs
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Michael E Stern
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Kriti Gogia
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Sunday Clark
- Boston Trauma Institute, Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Mary R Mulcare
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Andrew Greenway
- Division of Trauma, Burns, Acute and Critical Care, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Daniel Golden
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Rahul Sharma
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Palmer Q Bessey
- Division of Trauma, Burns, Acute and Critical Care, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York.
| |
Collapse
|
5
|
Jiang LG, Zhang Y, Greca E, Bodnar D, Gogia K, Wang Y, Peretz P, Steel PAD. Emergency Department Patient Navigator Program Demonstrates Reduction in Emergency Department Return Visits and Increase in Follow-up Appointment Adherence. Am J Emerg Med 2022; 53:173-179. [PMID: 35065524 DOI: 10.1016/j.ajem.2022.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/13/2021] [Accepted: 01/03/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND An estimated 56% of emergency department (ED) visits are avoidable. One motivation for return visits is patients' perception of poor access to timely outpatient care. Efforts to facilitate access may help reduce preventable ED visits. We aimed to analyze whether an ED patient navigator (PN) program improved adherence with outpatient appointments and reduced ED return visits. METHODS We performed a retrospective analysis of patients evaluated and discharged from two EDs from October 2016 to December 2019. Using propensity score matching, an intervention case group was matched against two control groups - patients similar to the case group who presented either (1) pre-PN intervention or (2) post-PN intervention and did not receive intervention. The four outcomes included 72-h return ED visits, 30-day return ED visits, overall ED utilization, as well as the intervention group's adherence rates to PN-scheduled outpatient appointments. From 482,896 charts, propensity matching led to a total of 14,295 patients in each group. RESULTS PN intervention decreased both acute and subacute ED return visits. Compared to both pre-PN and post-PN controls, navigated patients had a decrease in 72-h and 30-day return visits from 2% to 1% and 7% to 4% (p < 0.001) respectively. Navigated patients also had outpatient appointment adherence rates of 74-80% compared to the estimated national average of 25-56%. While there was no difference in mean ED utilization between the intervention group and pre-PN control group, mean ED utilization was found to be higher in the intervention group compared to the post-PN control group with 0.62 visits compared to 0.38 mean visits (p < 0.001). CONCLUSIONS By facilitating access to post-ED care, PNs may reduce avoidable ED utilization and improve outpatient follow-up adherence. While overall ED utilization did not change, this may be due to the overall vulnerability of the navigated group which is the goal PN intervention group.
Collapse
Affiliation(s)
- Lynn G Jiang
- Department of Emergency Medicine, NYP Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, United States of America
| | - Yiye Zhang
- Department of Population Health Sciences, Department of Emergency Medicine, NYP Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, United States of America
| | - Erina Greca
- Division of Community and Population Health, NYP Hospital, New York, United States of America
| | - David Bodnar
- Department of Emergency Medicine, NYP Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, United States of America
| | - Kriti Gogia
- NYC Health and Hospitals, New York, United States of America
| | - Yiwen Wang
- Department of Population Health Sciences, NYP Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, United States of America
| | - Patricia Peretz
- Division of Community and Population Health, NYP Hospital, New York, United States of America.
| | - Peter A D Steel
- Department of Emergency Medicine, NYP Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, United States of America
| |
Collapse
|
6
|
Abstract
OBJECTIVE Prior studies show that staffing a physician at triage expedites care in the emergency department. Our objective was to describe the novel application and effect of a telemedicine medical screening evaluation (Tele-MSE) at triage on quality metrics in the pediatric emergency department (PED). METHODS We conducted a retrospective quasi-experimental pre-post intervention study of patients presenting to an urban PED from December 2017 to November 2019 who received a Tele-MSE at triage. We analyzed 4 diagnostic cohorts: gastroenteritis, psychiatry evaluation, burn injury, and extremity fracture. We matched cases with controls who received standard triage, from December 2015 to November 2017, by age, diagnosis, weekday versus weekend, and season of presentation. Outcome measures included door-to-provider time, time-to-intervention order, and PED length of stay (LOS). RESULTS We included 557 patients who received Tele-MSE during the study period. Compared with controls, patients who received a Tele-MSE at triage had a shorter median door-to-provider time (median difference [MD], 8.4 minutes; 95% confidence interval [CI], 6.0-11.0), time-to-medication order (MD, 27.3 minutes; 95% CI, 22.9-35.2), time-to-consult order (MD, 10.0 minutes; 95% CI, 5.3-12.7), and PED LOS (MD, 0.4 hours; 95% CI, 0.3-0.6). CONCLUSIONS A Tele-MSE is an innovative modality to expedite the initiation of emergency care and reduce PED LOS for children. This novel intervention offers potential opportunities to optimize provider and patient satisfaction and safety during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Jonathan Friedman
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, New York City Health and Hospitals, Jacobi Medical Center; Division of Pediatric Emergency Medicine, Departments of
| | | | - Sunday Clark
- Department of Emergency Medicine, NewYork-Presbyterian, Weill Cornell Medicine, New York, NY
| | - Kriti Gogia
- Department of Emergency Medicine, NewYork-Presbyterian, Weill Cornell Medicine, New York, NY
| | | | | |
Collapse
|
7
|
Steel PAD, Siegal J, Zhang Y, Cato K, Greenwald P, Melville LD, Gogia K, Smith Z, Sharma R, Romney M. Telehealth follow up in emergency department patients discharged with COVID-like illness and exertional hypoxia. Am J Emerg Med 2021; 49:426-430. [PMID: 33722432 PMCID: PMC7919584 DOI: 10.1016/j.ajem.2021.02.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/17/2021] [Accepted: 02/24/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
- Peter A D Steel
- Weill Cornell Medicine, Department of Emergency Medicine, New York, NY, USA.
| | - Jonathan Siegal
- NewYork-Presbyterian Queens Hospital, Department of Emergency Medicine, New York, NY, USA
| | - Yiye Zhang
- Weill Cornell Medicine, Department of Emergency Medicine, New York, NY, USA
| | - Kenrick Cato
- Columbia University, Department of Emergency Medicine, New York, NY, USA
| | - Peter Greenwald
- Weill Cornell Medicine, Department of Emergency Medicine, New York, NY, USA
| | - Laura D Melville
- NewYork-Presbyterian Brooklyn-Methodist Hospital, Department of Emergency Medicine, New York, NY, USA
| | - Kriti Gogia
- Weill Cornell Medicine, Department of Emergency Medicine, New York, NY, USA
| | - Zachary Smith
- Weill Cornell Medicine, Department of Emergency Medicine, New York, NY, USA
| | - Rahul Sharma
- Weill Cornell Medicine, Department of Emergency Medicine, New York, NY, USA
| | - Marie Romney
- Columbia University, Department of Emergency Medicine, New York, NY, USA
| |
Collapse
|
8
|
Kim JW, Lame M, Szalay L, Lefchak B, Johnsson B, Gogia K, Clark S, Kessler D, Leyden D, Sharma R, Platt S. Telemedicine Surge for Pediatric Patients in Response to the COVID-19 Pandemic in New York City. Telemed J E Health 2021; 27:1105-1110. [PMID: 33428513 DOI: 10.1089/tmj.2020.0413] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Our objective is to describe our pediatric virtual urgent care (VUC) experience at a large urban academic medical center, in response to the COVID-19 pandemic in New York City (NYC). Materials and Methods: We conducted a retrospective cohort study of our pediatric VUC program of patients less than age 18 years, from March 1 to May 31, 2020. We include data on expansion of staffing, patient demographics, virtual care, and outcomes. Results: We rapidly onboarded, educated, and trained pediatric telemedicine providers. We evaluated 406 pediatric patients with median age 4.4 years and 53.9% male. Median call time was 5:12 pm, median time to provider was 5.7 min, and median duration of call was 11.1 min. The most common reasons for a visit were COVID-19-related symptoms (36%), dermatologic (15%), and trauma (10%). Virtual care for patients consisted of conservative management (72%), medication prescription (18%), and referral to an urgent care or pediatric emergency department (PED) (10%). Of 16 patients referred and presented to our emergency department, 2 required intensive care for multisystem inflammatory syndrome in children. Oral antibiotics were prescribed for 7.1% of all patients. Only 0.005% of patients had an unplanned 72-h PED visit resulting in hospitalization after a VUC visit. Conclusion: Pediatric emergency VUC allowed for high-quality efficient medical care for patients during the peak of the COVID-19 pandemic in NYC. Although most patients were managed conservatively in their home, telemedicine also enabled rapid identification of patients who required in-person emergency care.
Collapse
Affiliation(s)
- Ji Won Kim
- Department of Emergency Medicine, NewYork-Presbyterian and Weill Cornell Medicine, New York, New York, USA
| | - Maria Lame
- Department of Emergency Medicine, NewYork-Presbyterian and Weill Cornell Medicine, New York, New York, USA
| | - Leanna Szalay
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Brian Lefchak
- Department of Pediatrics, NewYork-Presbyterian and Weill Cornell Medicine, New York, New York, USA
| | - Bille Johnsson
- Department of Emergency Medicine, NewYork-Presbyterian and Weill Cornell Medicine, New York, New York, USA
| | - Kriti Gogia
- Department of Emergency Medicine, NewYork-Presbyterian and Weill Cornell Medicine, New York, New York, USA
| | - Sunday Clark
- Department of Emergency Medicine, NewYork-Presbyterian and Weill Cornell Medicine, New York, New York, USA
| | - David Kessler
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - David Leyden
- Department of Emergency Medicine, NewYork-Presbyterian and Weill Cornell Medicine, New York, New York, USA
| | - Rahul Sharma
- Department of Emergency Medicine, NewYork-Presbyterian and Weill Cornell Medicine, New York, New York, USA
| | - Shari Platt
- Department of Emergency Medicine, NewYork-Presbyterian and Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
9
|
Mulcare M, Naik N, Greenwald P, Schullstrom K, Gogia K, Clark S, Kang Y, Sharma R. Advanced Communication and Examination Skills in Telemedicine: A Structured Simulation-Based Course for Medical Students. MedEdPORTAL 2020; 16:11047. [PMID: 33365390 PMCID: PMC7751329 DOI: 10.15766/mep_2374-8265.11047] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/15/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Telemedicine has become part of mainstream medical practice. High quality virtual care is a skill that will be required of many physicians. Skills required for effective evaluation and communication during a video encounter differ from skills required at bedside, yet few rubrics for educational content and student performance evaluation in telemedicine training have been developed. Our objective was to develop, implement, and assess a training module designed to teach medical providers techniques to deliver professional, effective, and compassionate care during a telemedicine encounter. METHODS We created a simulation-based, 8-hour modular curriculum using the PEARLS debriefing framework with video-based encounters focused on "web-side manner" as a critical corollary to traditional bedside manner. We recorded simulated cases for each student with standardized patients, guided debriefs, and incorporated small-group exercises to teach advanced communication and examination skills. RESULTS Of medical students, 98 in their major clinical year participated in 2019. Of participants, 97% were enthusiastic about the course; 100% felt simulation was an effective mechanism for delivery of the educational material. After participation, 71% believed that telemedicine had the potential to become part of their future practice; 92% perceived an improvement in their comfort and ability to conduct video-based patient encounters. DISCUSSION Teaching telemedicine using this methodology was well received by students, providing early exposure to this evolving aspect of medical practice. Qualitative comments were used for targeted improvements of the content and delivery for curriculum development. Objective assessment tools of students completing telemedicine encounters need to be created.
Collapse
Affiliation(s)
- Mary Mulcare
- Assistant Professor of Clinical Emergency Medicine, Department of Emergency Medicine, New York-Presbyterian/Weill Cornell Medicine; Director, Undergraduate Medical Education for Department of Emergency Medicine, New York-Presbyterian/Weill Cornell Medicine
| | - Neel Naik
- Assistant Professor of Clinical Emergency Medicine, Department of Emergency Medicine, New York-Presbyterian/Weill Cornell Medicine; Director, Simulation Education for Department of Emergency Medicine, New York-Presbyterian/Weill Cornell Medicine
| | - Peter Greenwald
- Associate Professor of Clinical Emergency Medicine, Department of Emergency Medicine, New York-Presbyterian/Weill Cornell Medicine; Director, Telemedicine for Department of Emergency Medicine, New York-Presbyterian/Weill Cornell Medicine
| | - Kaitlin Schullstrom
- Undergraduate Medical Education Coordinator, Telehealth Services, Department of Emergency Medicine, New York-Presbyterian/Weill Cornell Medicine
| | - Kriti Gogia
- Research Analyst, Department of Emergency Medicine, New York-Presbyterian/Weill Cornell Medicine
| | - Sunday Clark
- Associate Professor of Emergency Medicine, Department of Emergency Medicine, New York-Presbyterian/Weill Cornell Medicine; Director, Research, New York-Presbyterian/Weill Cornell Medicine
| | - Yoon Kang
- Associate Professor of Medical Education, Office of Medical Education, Weill Cornell Medicine
| | - Rahul Sharma
- Professor of Clinical Emergency Medicine, Department of Emergency Medicine, New York-Presbyterian/Weill Cornell Medicine; Chair, Department of Emergency Medicine, New York-Presbyterian/Weill Cornell Medicine
| |
Collapse
|
10
|
Gogia K, Elman A, Clark S, Ulrey P, Connolly MT, Bloemen E, Johnsson B, Rosen T. Prosecution of Elder Neglect: A Close Examination of Cases From King County, Washington. Innov Aging 2020. [PMCID: PMC7741860 DOI: 10.1093/geroni/igaa057.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Elder neglect is common and can have catastrophic consequences. Cases may benefit from integrated responses from multiple sectors. Little research exists describing prosecutorial involvement and its impact, but existing evidence suggests neglect is seldom criminally prosecuted. Our goal was to closely examine neglect prosecution in a jurisdiction that has been a leader in using prosecution to attempt to address it. We quantitatively and qualitatively analyzed legal case files of felony elder neglect prosecuted in King County, Washington from 2008-2011. 13 cases were prosecuted, with a total of 10 victims. 90% of victims were female, with a median age of 88. 90% were unable to ambulate, and 90% had dementia. Defendants were commonly the victim’s adult child (38%). 23% had previous criminal citations/convictions. 46% of cases occurred in an Adult Family Home. 15% of cases went to trial, and all trial cases ended in conviction of some charge. Themes identified included: (1) perpetrators were either professional caregivers receiving compensation or non-professional caregivers financially dependent on the victim, (2) victims were malnourished and severely injured at time of reporting, and (3) medical expert contribution is imperative given complexity of these cases. Victims were unable to participate in prosecution in any case. This research shows that these cases are seldom prosecuted, even in a jurisdiction focusing on this phenomenon, but highlights characteristics of cases and demonstrates they may be prosecuted without victim participation. Future research is needed to examine prosecution’s impact on elder neglect to better understand how it may be optimally used.
Collapse
Affiliation(s)
- Kriti Gogia
- Weill Cornell Medicine, New York, New York, United States
| | - Alyssa Elman
- Weill Cornell Medicine, New York, New York, United States
| | - Sunday Clark
- Weill Cornell Medicine, New York, New York, United States
| | - Page Ulrey
- King County Prosecuting Attorney's Office, Seattle, Washington, United States
| | - Marie-Therese Connolly
- University of Southern California Leonard Davis School of Gerontology, Los Angeles, California, United States
| | - Elizabeth Bloemen
- University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Billie Johnsson
- NewYork-Presbyterian Hospital, New York, New York, United States
| | - Tony Rosen
- NewYork-Presbyterian Hospital, New York, New York, United States
| |
Collapse
|
11
|
Jeng K, Mou S, Ball S, Gogia K, Clark S, Sharma R, Stern M. 259 Correlation of Outpatient Laboratory Values With Acquired Immunodeficiency Syndrome-Defining Events in Older Emergency Department Patients. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
12
|
Nachum S, Gogia K, Clark S, Hsu H, Sharma R, Greenwald PW. An Evaluation of Kiosks for Direct-to-Consumer Telemedicine Using the National Quality Forum Assessment Framework. Telemed J E Health 2020; 27:178-183. [PMID: 32589518 DOI: 10.1089/tmj.2019.0318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Evaluation of direct-to-consumer (DTC) telemedicine programs has focused on care delivery via personal electronic devices. Telemedicine kiosks for the delivery of virtual urgent care services have not been systematically described. Introduction: Our institution has placed kiosks for DTC urgent care in pharmacies. These kiosks can be used without a personal electronic device. Materials and Methods: Retrospective review of adult patients using pharmacy-based kiosks (kiosk) or personal electronic devices (app) for DTC evaluation. Data for patient characteristics, wait time, technical quality, visit duration diagnosis codes, follow-up recommendations, and whether the patient was traveling were compared. Results were interpreted using the National Quality Forum framework for telemedicine service evaluation, focused on access, experience, and effectiveness. Comparisons were made using chi-square test, Student's t-test, and Wilcoxon rank-sum tests. Results: Over 1 year there were 1,996 DTC visits; 238 (12%) initiated from kiosks. Kiosk patients were slightly older (mean age 38 ± 13 vs. 35 ± 11; p < 0.001), more likely to be male (52% vs. 39%; p < 0.001), more likely to be remote from home (25% vs. 3%; p < 0.001), and had less technical difficulty (10% vs. 19%; p = 0.003). Referral for urgent in-person evaluation was low in both groups (10% kiosk vs. 16%; app p = 0.017). Discussion: Kiosks may increase access to care and improve technical experience. Low urgent referral rates suggest effective care for both types of visit. Conclusions: Despite their potential advantages, kiosk visits accounted for a minority of overall visits for our DTC telemedicine service line, and daily use of each kiosk location was low.
Collapse
Affiliation(s)
- Sapir Nachum
- Department of Medicine and Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Kriti Gogia
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Hanson Hsu
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Rahul Sharma
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Peter W Greenwald
- Department of Emergency Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| |
Collapse
|
13
|
Rosen T, LoFaso VM, Bloemen EM, Clark S, McCarthy TJ, Reisig C, Gogia K, Elman A, Markarian A, Flomenbaum NE, Sharma R, Lachs MS. Identifying Injury Patterns Associated With Physical Elder Abuse: Analysis of Legally Adjudicated Cases. Ann Emerg Med 2020; 76:266-276. [PMID: 32534832 DOI: 10.1016/j.annemergmed.2020.03.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 03/04/2020] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE Elder abuse is common and has serious health consequences but is underrecognized by health care providers. An important reason for this is difficulty in distinguishing between elder abuse and unintentional trauma. Our goal was to identify injury patterns associated with physical elder abuse in comparison with those of patients presenting to the emergency department (ED) with unintentional falls. METHODS We partnered with a large, urban district attorney's office and examined medical, police, and legal records from successfully prosecuted cases of physical abuse of victims aged 60 years or older from 2001 to 2014. RESULTS We prospectively enrolled patients who presented to a large, urban, academic ED after an unintentional fall. We matched 78 cases of elder abuse with visible injuries to 78 unintentional falls. Physical abuse victims were significantly more likely than unintentional fallers to have bruising (78% versus 54%) and injuries on the maxillofacial, dental, and neck area (67% versus 28%). Abuse victims were less likely to have fractures (8% versus 22%) or lower extremity injuries (9% versus 41%). Abuse victims were more likely to have maxillofacial, dental, or neck injuries combined with no upper and lower extremity injuries (50% versus 8%). Examining precise injury locations yielded additional differences, with physical elder abuse victims more likely to have injuries to the left cheek or zygoma (22% versus 3%) or on the neck (15% versus 0%) or ear (6% versus 0%). CONCLUSION Specific, clinically identifiable differences may exist between unintentional injuries and those from physical elder abuse. This includes specific injury patterns that infrequently occur unintentionally.
Collapse
Affiliation(s)
- Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY.
| | - Veronica M LoFaso
- Division of Geriatrics and Palliative Care, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | | | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | | | - Christopher Reisig
- Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | - Kriti Gogia
- Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | - Arlene Markarian
- Elder Abuse Unit, King's County District Attorney's Office, Brooklyn, NY
| | - Neal E Flomenbaum
- Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | - Rahul Sharma
- Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | - Mark S Lachs
- Division of Geriatrics and Palliative Care, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| |
Collapse
|
14
|
Dion S, Gogia K, Elman A, Clark S, Ulrey P, Connolly MT, Lewis S, LoFaso VM, Lachs MS, Wartell J, Rosen T. Developing a rigorous, systematic methodology to identify and categorize elder mistreatment in criminal justice data. J Elder Abuse Negl 2020; 32:27-45. [PMID: 32151210 DOI: 10.1080/08946566.2020.1733725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Elder mistreatment is complex, with cases typically requiring integrated responses from social services, medicine, civil law, and criminal justice. Only limited research exists describing elder mistreatment prosecution and its impact. Researchers have not yet examined administrative prosecutorial data to explore mistreatment response, and no standardized analytic approach exists. We developed a rigorous, systematic methodologic approach to identify elder mistreatment cases in prosecutorial data from cases of crimes against victims aged ≥60. To do so, we operationalized elements of the accepted definition of elder mistreatment, including expectation of trust and vulnerability. We also designed an approach to categorize elder mistreatment cases, using the types of charges filed, into: financial exploitation, physical abuse, sexual abuse, verbal/emotional/psychological abuse, and neglect. This standardized methodological approach to identify and categorize elder mistreatment cases in prosecution data is an important preliminary step in analyzing this potentially untapped source of useful information about mistreatment response.
Collapse
Affiliation(s)
- Sarah Dion
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kriti Gogia
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Alyssa Elman
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Page Ulrey
- Economic Crimes Unit, King County Prosecuting Attorney's Office, Seattle, Washington, USA
| | - Marie-Therese Connolly
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Stuart Lewis
- School of Medicine, New York University, New York, New York, USA
| | - Veronica M LoFaso
- Division of Geriatrics and Palliative Care, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Mark S Lachs
- Division of Geriatrics and Palliative Care, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Julie Wartell
- Department of Urban Studies and Planning, University of California, San Diego, California, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| |
Collapse
|
15
|
Hsu H, Greenwald PW, Clark S, Gogia K, Laghezza MR, Hafeez B, Sharma R. Telemedicine Evaluations for Low-Acuity Patients Presenting to the Emergency Department: Implications for Safety and Patient Satisfaction. Telemed J E Health 2020; 26:1010-1015. [PMID: 31930952 DOI: 10.1089/tmj.2019.0193] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Telemedicine is being rapidly adopted by traditional health care systems. We have used telemedicine in a program we call Express Care to allow a single physician to remotely perform evaluations of low-acuity patients. Materials and Methods: We conducted a retrospective cohort study of quality assurance data comparing low-acuity patients treated by an emergency department (ED) physician through telemedicine (Express Care) with those treated by an ED physician in person between July 16, 2016 and September 30, 2017. We compared patient demographics, length of stay (LOS), visit severity as measured by emergency severity index (ESI), visit diagnosis type, return visits, and patient satisfaction scores. Results: There were 3,266 low-acuity patients seen through telemedicine and 21,129 seen in person during the observation period. Patients receiving evaluation by telemedicine were younger (mean age ± standard deviation [in years]: 42 ± 18 vs. 45 ± 17; p < 0.001) and more likely to be male (51% vs. 46%; p < 0.001). Median ESI was slightly lower for patients treated by telemedicine [4 (4-5) vs. 4 (4-4); p < 0.001], and there were modest differences in diagnosis type between the two groups. Median ED LOS was 63.6 (interquartile range [IQR] 42.6-93.6) min for telemedicine patients and 133.8 (IQR 90.6-196.8) min for patients seen in person (p < 0.001). Seventy-two hour returns (3.4% vs. 3.0%; p = 0.302) and 72-h returns requiring admission (0.2% vs. 0.3%; p = 0.252) were similar between groups. Patient satisfaction scores were also similar between the groups. Conclusion: Telemedicine evaluation for ED patients can be effective and safe when treating low-acuity conditions without compromising patient satisfaction.
Collapse
Affiliation(s)
- Hanson Hsu
- Department of Emergency Medicine, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Peter W Greenwald
- Department of Emergency Medicine, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Sunday Clark
- Department of Emergency Medicine, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Kriti Gogia
- Department of Emergency Medicine, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Matthew R Laghezza
- Department of Emergency Medicine, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Baria Hafeez
- Department of Emergency Medicine, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Rahul Sharma
- Department of Emergency Medicine, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
16
|
Yao P, Clark S, Gogia K, Hafeez B, Hsu H, Greenwald P. Antibiotic Prescribing Practices: Is There a Difference Between Patients Seen by Telemedicine Versus Those Seen In-Person? Telemed J E Health 2020; 26:107-109. [DOI: 10.1089/tmj.2018.0250] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Peter Yao
- Weill Cornell Medical College, New York, New York
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medical Center, New York, New York
| | - Kriti Gogia
- Department of Emergency Medicine, Weill Cornell Medical Center, New York, New York
| | - Baria Hafeez
- Department of Emergency Medicine, Weill Cornell Medical Center, New York, New York
| | - Hanson Hsu
- Department of Emergency Medicine, Weill Cornell Medical Center, New York, New York
| | - Peter Greenwald
- Department of Emergency Medicine, Weill Cornell Medical Center, New York, New York
| |
Collapse
|
17
|
Greenwald PW, Stern M, Clark S, Hafeez B, Gogia K, Hsu H, Mulcare M, Sharma R. A Novel Emergency Department-Based Telemedicine Program: How Do Older Patients Fare? Telemed J E Health 2019; 25:966-972. [DOI: 10.1089/tmj.2018.0162] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Peter W. Greenwald
- Department of Emergency Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Michael Stern
- Department of Emergency Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Sunday Clark
- Department of Emergency Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Baria Hafeez
- Department of Emergency Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Kriti Gogia
- Department of Emergency Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Hanson Hsu
- Department of Emergency Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Mary Mulcare
- Department of Emergency Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Rahul Sharma
- Department of Emergency Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| |
Collapse
|
18
|
Liu AYL, Gogia K, Clark S, Rao R. 374 Knowledge, Attitudes, and Behaviors Regarding Care of Sexual Assault Survivors in the Emergency Department. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
19
|
Cai A, Gogia K, Johnsson B, Bloemen E, Clark S. 171 Predictors of Repeat Emergency Department Visits in Older Adults. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
20
|
Rosen T, Elman A, Gogia K, Ulrey P, Connolly M, Lewis S, Lachs M, Clark S. PROSECUTING ELDER ABUSE, NEGLECT, AND EXPLOITATION: EXAMINATION OF A LARGE, URBAN U.S. COUNTY, 2008–2011. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Rosen
- Weill Cornell Medical College
| | | | - K Gogia
- Weill Cornell Medical College
| | - P Ulrey
- King County Prosecuting Attorney’s Office
| | - M Connolly
- Woodrow Wilson International Center for Scholars
| | - S Lewis
- New York University School of Medicine
| | - M Lachs
- Weill Cornell Medical College
| | - S Clark
- Weill Cornell Medical College
| |
Collapse
|