{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T04:17:37Z","timestamp":1783829857965,"version":"3.55.0"},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T00:00:00Z","timestamp":1677628800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000909","name":"John A. Hartford Foundation","doi-asserted-by":"publisher","award":["VA GEDA award 2020\u20102022"],"award-info":[{"award-number":["VA GEDA award 2020\u20102022"]}],"id":[{"id":"10.13039\/100000909","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>In 2018, the U.S. Department of Veterans Affairs (VA) National Office of Geriatrics and Extended Care (GEC) and the National Emergency Medicine (EM) Program partnered to improve emergency care for older Veterans. A core team disseminated age\u2010friendly models of care via education and standardization of practice with the goal of multisite geriatric emergency department (GED) accreditation. We compare rates of GED screening at VAs with GED implementation to those without.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Observational evaluation of GED screening of older Veterans (\u226565\u2009years) at VA Emergency Departments (ED) from January 2018 to March 2022, during peak pandemic years. Data were extracted from the VA Corporate Data Warehouse of Veteran ED visit encounters to track documented GED screens and Veteran demographic data. Generalized estimating equation models were used to compare screening completion across different levels of GED accreditation, adjusting for potential confounding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During this period, over 1.07\u2009million Veterans \u2265\u200965\u2009years of age made 4.07\u2009million VA ED visits. Mean (\u00b1SD) age was 73.4 (\u00b17.2)\u00a0years, 96.5% were male, 68% were White, and 89.9% made their index ED visit at a non\u2010GED VA ED. As of early 2022, a total of 50 of 111 VA EDs have achieved or applied for GED accreditation. During early 2022, 8.3% of all visits by older Veterans had at least one GED screen documented; 15% were screened at Levels 1\u20133 GED versus 2.2% at non\u2010GED facilities. Screens identifying older adults at risk for poor outcomes, for delirium, and for falls had the highest usage rates within VA GEDs. Veterans seen at Level 1 GEDs had a 76\u2010fold greater odds of having a GED screen than at Level 3 GEDs (odds ratio\u200975.8, 95% confidence interval 72.8\u201379.0).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Through VA National Office of GEC and EM Program partnership, the VA has created, standardized, and disseminated a GED Model of Care, despite the pandemic. GED accreditation was associated with GED screen implementation, with Level 1 having the highest screening prevalence.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14665","type":"journal-article","created":{"date-parts":[[2023,1,19]],"date-time":"2023-01-19T05:49:16Z","timestamp":1674107356000},"page":"270-277","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Dissemination and implementation of age\u2010friendly care and geriatric emergency department accreditation at <scp>Veterans Affairs<\/scp> hospitals"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3715-3073","authenticated-orcid":false,"given":"Ula","family":"Hwang","sequence":"first","affiliation":[{"name":"Geriatric Research Education and Clinical Center James J. Peters VA Medical Center  Bronx New York USA"},{"name":"Department of Emergency Medicine Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tessa","family":"Runels","sequence":"additional","affiliation":[{"name":"Pain Research, Informatics, Multi\u2010morbidities, and Education (PRIME) Center VA Connecticut Healthcare System  West Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Han","sequence":"additional","affiliation":[{"name":"Pain Research, Informatics, Multi\u2010morbidities, and Education (PRIME) Center VA Connecticut Healthcare System  West Haven Connecticut USA"},{"name":"Department of Internal Medicine Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0103-9666","authenticated-orcid":false,"given":"Erica","family":"Gruber","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Richard L. Roudebush VA Medical Center  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen M.","family":"McQuown","sequence":"additional","affiliation":[{"name":"Geriatric Research Education and Clinical Center Louis Stokes Cleveland VA Medical Center  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luna","family":"Ragsdale","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Durham VA Health Care System  Durham North Carolina USA"},{"name":"Department of Surgery, Division of Emergency Medicine Duke University Hospital  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0416-469X","authenticated-orcid":false,"given":"Ethan","family":"Jetter","sequence":"additional","affiliation":[{"name":"Veteran Affairs National Emergency Medicine Office  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Rossomano","sequence":"additional","affiliation":[{"name":"Veteran Affairs National Emergency Medicine Office  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Javier","sequence":"additional","affiliation":[{"name":"Veteran Affairs National Emergency Medicine Office  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,3]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2007.01400.x"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12415"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2014.03.002"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12883"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2021.06.013"},{"key":"e_1_2_10_7_1","unstructured":"Geriatric emergency department guidelines.College of Emergency Physicians American Geriatrics Society Emergency Nurses Association Society for Academic Emergency Medicine.http:\/\/geriatricscareonline.org\/ProductAbstract\/geriatric\u2010emergency\u2010department\u2010guidelines\/CL013\/?param2=search"},{"key":"e_1_2_10_8_1","unstructured":"2021 National Emergency Department Inventory \u2010 USA.Emergency Medicine Network (EMNet) Nationla Emergency Department Inventories (NEDI). Accessed September 24 2022.2022.https:\/\/www.emnet\u2010usa.org\/research\/studies\/nedi\/nedi2021\/"},{"key":"e_1_2_10_9_1","unstructured":"Geriatric Emergency Department Accredited Program.American College of Emergency Physicians. Accessed September 24 2022 2022.https:\/\/www.acep.org\/geda\/"},{"key":"e_1_2_10_10_1","unstructured":"Emergency medicine management tool age report.Veterans Health Administration.2022."},{"key":"e_1_2_10_11_1","unstructured":"National Hospital Ambulatory Medical Care Survey: 2018 Emergency department summary tables.U.S. Department of Health and Human Services. Accessed January 1 2022.https:\/\/www.cdc.gov\/nchs\/data\/nhamcs\/web_tables\/2018\u2010ed\u2010web\u2010tables\u2010508.pdf"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12417"},{"key":"e_1_2_10_13_1","volume-title":"Building capacity for excellence in geriatric acute and emergency care in the Veterans Health Administration \u2010 executive summary report \u2010 spring 2018","author":"Hwang U","year":"2018"},{"key":"e_1_2_10_14_1","unstructured":"Age\u2010friendly health systems.American Hospital Association Center for Health Innovation. Accessed August 28 2022.https:\/\/www.aha.org\/center\/age\u2010friendly\u2010health\u2010systems"},{"key":"e_1_2_10_15_1","unstructured":"The Geriatric Emergency Department Collaborative \u2010 educate implement evaluate.The Geriatric Emergency Department Collaborative. 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