UW–Madison researchers led by Dr. Manish Shah are part of a national effort to improve health outcomes for people living with dementia by investigating multiple strategies to advance health care delivery during and after visits to an emergency department (ED). Through a $55 million research grant funded by the National Institutes of Health, researchers will implement a large nationwide trial that will provide insight as to how standard of care interventions found to be beneficial in smaller, single-site trials may be effective in more diverse settings.
Manish N. Shah, MD, MPH, professor and chair of the BerbeeWalsh Department of Emergency Medicine, and an emergency physician with UW Health, is one of four investigators leading a five-year, 80-site pragmatic clinical trial evaluating focused emergency and post-emergency care interventions for patients living with dementia and their informal care partners.
A nationally recognized expert in geriatric emergency care, Dr. Shah is part of an experienced, interdisciplinary team of investigators at the helm of the Emergency Departments LEading the Transformation of Alzheimer’s and Dementia care (ED-LEAD) study, which is funded by a $55 million, five-year cooperative grant from the National Institute on Aging of the National Institutes of Health.
Jointly led by the University of Wisconsin School of Medicine and Public Health, New York University’s College of Nursing and Grossman School of Medicine, and Memorial Sloan Kettering Hospital, the trial will test three interventions — redesigning the ED experience, nurse-led telephone-based care, and transitional care delivered by paramedics. Each intervention is designed to reduce future ED visits and hospital admissions and improve quality care and care coordination for patients with dementia who are discharged home from the emergency department.
The ED can be a stressful environment for people with dementia, as well as for their care partners. Persons living with dementia (PLWD) are significantly more likely to visit the ED, be hospitalized, and return to the ED more frequently than those without dementia. Developing adequate post-emergency care transitions is an area with great potential to address unmet clinical and social needs that often precipitate an ED visit and improve health outcomes when ED care is needed.
“Providing adequate emergency and post-emergency care for people with dementia is an important challenge our society faces because this population is growing quickly,” Dr. Shah says, as the number of people with dementia in the United States is expected to double in the next 25 years.
Dr. Shah will lead the Community Paramedic-led Transition Intervention (CPTI), which he previously developed and tested with a team of emergency medicine researchers at UW–Madison. In the CPTI, persons with dementia and their care partners receive individualized coaching from a trained community paramedic during one home visit within 5 days of being discharged from the ED and up to three follow-up phone calls. Coaching may include education on managing medications, coordinating outpatient follow-up, identifying red flag symptoms, maintaining a patient-centered health record, and referring individuals to resources as needed.
“By focusing interventions on reducing future revisits and potential hospitalization,” Shah notes, “we are addressing a major concern for people living with dementia and their families and providing an opportunity to reduce stressful, costly and often under-reimbursed medical care.”
The ED-LEAD study will consist of two phases. During its first year, researchers will focus on refining and preparing interventions for rollout to a diverse group of 14 health systems, including 80 EDs with racial, ethnic, economic and regional diversity. UW Health’s University Hospital in Madison and NYU Langone Health will serve as phase one trial sites.
Phase two will test the effectiveness of the interventions at reducing the frequency of ED revisits and increasing the number of health days an older adult with dementia has at home after being discharged from the emergency department. The 80 EDs will be randomly assigned none, one, or a combination of the three interventions to determine what strategies are most effective. UW Health’s East Madison Hospital will be included in the second, randomized phase of the trial.
The impressive scope and scale of the ED-LEAD trial “reflects the urgency of improving emergency care for the nearly 7 million people in the U.S. living with dementia,” Andrea Gilmore-Bykovskyi, PhD, RN says, an associate professor and associate vice chair of research at the BerbeeWalsh Department of Emergency Medicine, and a study contributor. “ED-LEAD’s ambitious and attainable objectives hold great potential to guide improvements and define new standards in emergency care practices for patients with dementia.”
Other emergency medicine researchers at the UW School of Medicine and Public Health contributing to the ED-LEAD study include Brian Patterson, MD, MPH, associate professor, and medical informatics director for predictive analytics and clinical decision support, UW Health; Michael Spigner, MD, EMT-P, assistant professor and director of prehospital medicine informatics; and Meghan Jenkins Morales, PhD, MSW, scientist.
This research is being supported by a grant from the National Institutes of Health (U19AG078105).