Social determinants and emergency department utilization: Findings from the Veterans Health Administration

Davis, Camille; Montgomery, Ann Elizabeth; Dichter, Melissa E.; Taylor, Laura D.; Blosnich, John R.

doi:10.1016/j.ajem.2020.05.078

Cited by 33 publications

(23 citation statements)

References 46 publications

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“…Their contemporary relevance is evidenced by priority within the 2014 Geriatric ED Guidelines, 24 the 2017 National Quality Forum ED Transitions of Care Report, 25 the 2018 launch of the American College of Emergency Physicians tiered geriatric ED accreditation process, 26 the growing role of social emergency medicine, [27][28][29][30] and the Social Interventions Research & Evaluation Network (SIREN). 31 Despite this increased interest and a multitude of observational studies that have documented high rates of social needs in older ED patients, [32][33][34] it is unclear whether care transition interventions address social including, but not limited to, geriatric patients) as well as a lack of accounting for a broad and inclusive range of social needs that are increasingly recognized to play a significant role in successful care transitions. 22,[35][36][37] Knowledge of prior successes and identification of key research questions going forward will be crucial to implement effective patient-centered interventions in the growing older adult population.…”

Section: Introductionmentioning

confidence: 99%

Care transitions and social needs: A Geriatric Emergency care Applied Research (GEAR) Network scoping review and consensus statement

Bristol

Gladney

Seidenfeld

et al. 2021

Academic Emergency Medicine

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Section: Introductionmentioning

confidence: 99%

Care transitions and social needs: A Geriatric Emergency care Applied Research (GEAR) Network scoping review and consensus statement

Bristol

Gladney

Seidenfeld

et al. 2021

Academic Emergency Medicine

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“…In addition to Andersen and Newman’s model, other frameworks have been used to explain health services utilization. These include the Health Belief Model [ 24 , 25 ], Social Determinants of Health [ 26 ] as well as Big Five personality traits [ 27 , 28 ]. Lutz et al devised a framework to understand ED utilisation by describing the factors that influence the decision of visiting the ED or primary care [ 29 ].…”

Section: Introductionmentioning

confidence: 99%

Emergency department utilisation among older adults—Protocol for a systematic review of determinants and conceptual frameworks

et al. 2022

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Background Older adults aged 65 years and above have a disproportionately higher utilization of emergency healthcare, of which Emergency Department (ED) visits are a key component. They experience higher degree of multimorbidity and mobility issues compared to younger patients, and are consequently more likely to experience a health event which requires an ED visit. During their visit, older adults tend to require more extensive workup, therefore spending a greater amount of time in the ED. Compared to the younger population, older adults are more susceptible to adverse events following discharge. Considering these factors, investigating the determinants of ED utilisation would be valuable. In this paper, we present a protocol for a systematic review of the determinants of ED utilisation among communitydwelling older adults aged 65 years and above, applying Andersen and Newman’s model of healthcare utilisation. Furthermore, we aim to present other conceptual frameworks for healthcare utilisation and propose a holistic approach for understanding the determinants of ED utilisation by older persons. Methods The protocol is developed in accordance with the standards of Campbell Collaboration guidelines for systematic reviews, with reference to the Cochrane Handbook for Systematic Review of Interventions. Medline, Embase and Scopus will be searched for studies published from 2000 to 2020. Studies evaluating more than one determinant for ED utilisation among older adults aged 65 years and above will be included. Search process and selection of studies will be presented in a PRISMA flow chart. Statistically significant (p < 0.05) determinants of ED utilisation will be grouped according to individual and societal determinants. Quality of the studies will be assessed using Newcastle Ottawa Scale (NOS). Discussion In Andersen and Newman’s model, individual determinants include predisposing factors, enabling and illness factors, and societal determinants include technology and social norms. Additional conceptual frameworks for healthcare utilisation include Health Belief Model, Social Determinants of Health and Big Five personality traits. By incorporating the concepts of these models, we hope to develop a holistic approach of conceptualizing the factors that influence ED utilisation among older people. Systematic review registration This protocol is registered on 8 May 2021 with PROSPERO’s International Prospective Register of Systematic Reviews (CRD42021253770).

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“…[1][2][3][4] Recent scholarship in emergency medicine (EM) has turned to studying the upstream drivers of disenfranchised patients' reliance on ED services and the structural barriers to their overall health and well-being. [5][6][7][8] Similarly, EM educators have called for training structurally competent physicians-ones engaged in lifelong learning and self-reflection to recognize and respond to societal forces and structures that affect signs and symptoms of individual illness. 9 "Structural competency," first proposed by Metzl and Hansen, is defined as the trained ability for health professionals to recognize and respond to signs and symptoms of individual illness as the downstream effects of broad historical, social, political, and economic structures.…”

Section: Introductionmentioning

confidence: 99%

“…The emergency department (ED) has long been recognized as the “safety net” of the U.S. health care system, providing acute care, primary care, and a range of other services to the most disenfranchised patients and populations 1‐4 . Recent scholarship in emergency medicine (EM) has turned to studying the upstream drivers of disenfranchised patients’ reliance on ED services and the structural barriers to their overall health and well‐being 5‐8 . Similarly, EM educators have called for training structurally competent physicians—ones engaged in lifelong learning and self‐reflection to recognize and respond to societal forces and structures that affect signs and symptoms of individual illness 9 …”

Section: Introductionmentioning

confidence: 99%

Structural competency in emergency medical education: A scoping review and operational framework

Salhi

Zeidan

Stehman

et al. 2022

AEM Education and Training

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Objectives Existing curricula and recommendations on the incorporation of structural competency and vulnerability into medical education have not provided clear guidance on how best to do so within emergency medicine (EM). The goal of this scoping review and consensus building process was to provide a comprehensive overview of structural competency, link structural competency to educational and patient care outcomes, and identify existing gaps in the literature to inform curricular implementation and future research in EM. Methods A scoping review focused on structural competency and vulnerability following Arksey and O’Malley’s six‐step framework was performed in concurrence with a multistep consensus process culminating in the 2021 SAEM Consensus Conference. Feedback was incorporated in developing a framework for a national structural competency curriculum in EM. Results A literature search identified 291 articles that underwent initial screening. Of these, 51 were determined to be relevant to EM education. The papers consistently conceptualized structural competency as an interdisciplinary framework that requires learners and educators to consider historical power and privilege to develop a professional commitment to justice. However, the papers varied in their operationalization, and no consensus existed on how to observe or measure the effects of structural competency on learners or patients. None of the studies examined the structural constraints of the learners studied. Conclusions Findings emphasize the need for training structurally competent physicians via national structural competency curricula focusing on standardized core competency proficiencies. Moreover, the findings highlight the need to assess the impact of such curricula on patient outcomes and learners’ knowledge, attitudes, and clinical care delivery. The framework aims to standardize EM education while highlighting the need for further research in how structural competency interventions would translate to an ED setting and affect patient outcomes and experiences.

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Social determinants and emergency department utilization: Findings from the Veterans Health Administration

Cited by 33 publications

References 46 publications

Care transitions and social needs: A Geriatric Emergency care Applied Research (GEAR) Network scoping review and consensus statement

Care transitions and social needs: A Geriatric Emergency care Applied Research (GEAR) Network scoping review and consensus statement

Emergency department utilisation among older adults—Protocol for a systematic review of determinants and conceptual frameworks

Structural competency in emergency medical education: A scoping review and operational framework

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