Development and Pilot Testing of an Electronic Health Record-based Serious Illness Communication Intervention for Older Adults in the Emergency Department

About This Grant

PROJECT ABSTRACT This is a National Institute on Aging (NIA) K23 proposal from Adrian Haimovich, MD/PhD, an emergency medicine physician-scientist at Beth Israel Deaconess Medical Center and Harvard Medical School. Dr. Haimovich is committed to becoming a national leader at the intersection of geriatric acute care, data science, and electronic health record (EHR) interventions. While 75% of adults aged ≥65 years will visit an emergency department (ED) within six months of dying, few ED clinicians incorporate patient end-of-life values into medical treatment plans leading to goal-discordant care. In alignment with the new CMS Age Friendly Hospital Measure, the goal of this proposal is to develop an EHR-embedded, transdisciplinary serious illness communication intervention for the emergency department (SIC-ED) to help emergency clinicians solicit the goals, values, and preferences of older adults at the end-of-life and incorporate them into decision-making. With funding from an NIA T32 at Hebrew SeniorLife and a Harvard KL2, Dr. Haimovich developed the Geriatric End-of-life Screening Tool (GEST), an automatable logistic regression algorithm that uses EHR data to identify older adults in the ED with limited life expectancy for the SIC-ED intervention. Dr. Haimovich also performed a survey of 100 ED patients aged ≥65 years, finding that only 37% of older adults in the ED had spoken to their doctor about the type of care they would want to receive if they were very sick or at the end of life. To address this gap, SIC-ED will incorporate four evidence-based facilitators of serious illness communication: (1) proactive patient identification with GEST, a multilevel intervention comprised of (2) a patient activation questionnaire and (3) engages transdisciplinary ED teams (e.g., physicians, nurses, and social workers), and (4) be designed for EHR integration. Following the SALIENT EHR implementation framework, Dr. Haimovich will (1) prospectively validate GEST over 3 months, (2) develop SIC-ED using a stakeholder-informed human- centered design process, and (3) assess feasibility, acceptability, and preliminary efficacy in a two-site single- arm pilot. The proposed 5-year plan accelerates Dr. Haimovich's career development as an independent physician-scientist through training in (1) implementation of EHR predictive models, (2) human centered design of EHR interventions, (3) conduct of clinical trials, and (4) leadership in geriatric emergency care. Dr. Haimovich's mentorship team incorporates research expertise in implementing shared decision-making with older adults, ED clinical trials, and ED palliative care. The culmination of this career development award will ensure Dr. Haimovich has the advanced research skills and knowledge required to conduct a large, multi-site trial of SIC-ED. The goal of this research is to establish SIC-ED as the national standard of care to help ED clinicians incorporate the goals, values, and preferences of seriously ill older adults in their care.