e-GAPcare: Expanding the Reach of a Fall Prevention Intervention for Older Adult Emergency Department Patients through Telehealth - PROJECT SUMMARY From Dr. Goldberg’s (principal investigator’s) NIA GEMSSTAR R03 and BEESON K76 research, there is promising evidence that we can prevent fall-related emergency department (ED) visits among older adults with the Geriatric Acute and Post-Acute Fall Prevention (GAPcare) intervention. The GAPcare randomized, controlled trial (RCT) (n=110, two sites) had high patient and caregiver satisfaction, did not prolong ED length of stay, and resulted in 66% fewer 6-month fall-related ED visits, as compared to usual ED care. However, GAPcare requires in-person pharmacists and physical therapists (PTs), which limits scalability to large EDs, which account for only 43.8% of all ED visits. If we fail to scale this intervention, valuable prevention opportunities will be missed for the 3 Million older Americans who seek care for falls in EDs each year. Our over-arching goal is to expand the reach of GAPcare by testing a video telehealth GAPcare (e-GAPcare) intervention in a community ED without existing pharmacy and PT services. The rationale for this research is that telehealth for specialist evaluations have already been successfully implemented in EDs, suggesting that GAPcare could be adapted for patients with falls who would benefit from pharmacy and PT consultation, but cannot receive them due to staffing limitations in rural or smaller community EDs. Our long-term goal is to prevent fall-related ED visits. The objective of this R21 is to evaluate feasibility outcomes, assess acceptability, and to obtain estimates of effect on the outcome measures. Our central hypothesis is that e-GAPcare will help ED clinicians identify fall risk factors, such as gait, balance, and fall-risk increasing medication, and could ameliorate these risk factors through action plans co-created with patients preventing the next fall. GAPcare’s specific aims are to: (1) qualitatively elicit perspectives from content experts in telehealth (n=18- 24) to gain insights about the practical considerations of implementing telehealth consultation in the ED; (2) Adapt the GAPcare intervention and study protocol based on interviews with experts and workgroup feedback from ED staff, patient and caregivers (n=20); and (3) determine feasibility of e-GAPcare by conducting a single arm feasibility study with older ED patients (n=40) with a recent fall. Feasibility measures include our ability to recruit and retain participants, complete telehealth consults, and participants’ ability to initiate and perform necessary actions (with or without staff assistance). We will also assess acceptability using the Net Promoter Score and uptake of action plans. Using phone calls at 1, 3, 6 months and the electronic health record we will measure subsequent 6-month ED visits for falls, to inform initial efficacy for our subsequent large-scale RCT. Upon successful completion of this research, we will have a fully piloted telehealth intervention tailored to the unique health needs of older adults. This contribution is expected to be significant because it will provide a mechanism for patients in smaller or rural EDs to access geriatric-trained professionals and achieve health outcomes – reduced ED visits for falls – like patients in higher resourced larger academic medical centers.
