Table 1.

Summary Research Priorities: AHRQ Palliative Care Workgroup with supporting geriatric research agendas

Domain	Description	New Frontiers—Geriatric Emergency Medicine (Emerg Med num)8/Geriatric Core Competencies5
Descriptive	Accurate characterization of ED and prehospital patients with acute severe and advanced chronic serious illness.	Emerg Med 2 (Level A): Randomized controlled trials are needed to assess the effectiveness of interventions (e.g., educational models, standardized protocols) for improving quality of care of older ED patients. Emerg Med 4 (Level A): Following evidence-based identification of target areas for improvement, controlled studies of the effect of alterations in the microenvironment on outcomes for older ED patients should be performed. Such studies likely cannot be based on random assignments of individuals to interventions; rather, whole microenvironments will have to be compared. Emerg Med 37 (Level B): Systematic reviews and, when possible, meta-analyses are needed to summarize the best available diagnostic, prognostic, and therapeutic evidence with regard to care for older adults presenting to the ED. These reviews should follow established protocols, such as the Cochrane review methodology, including planned periodic updates.
Attitudinal	Further study of knowledge, attitudes, and skills barriers to effective implementation of palliative care in the emergency setting. Achieve consensus approach on the role of emergency care in palliative and end-of-life care assessment and management.	Emerg Med 35 (Level C): Systematic evaluation of training effectiveness on clinically important outcomes is needed. This evaluation should begin with an assessment of the attitudes, knowledge, and skills of residents who participate in any program to improve emergency care for older adults.
Screening	Identification of valid and reliable ED focused palliative care screening tools and triggers that drive quality of care.	Emerg Med 16 (Level B): Studies are needed to develop brief screening instruments for specific conditions for use with older patients in the ED.
Outcomes	Assessment of value added to care when palliative interventions are initiated in the emergency setting. Assessment of interventions initiated in the emergency setting and their summative impact.	Emerg Med 34 (Level A): Randomized controlled trials with blinded outcome assessors and controlled interventions are needed to study whether measures to improve clinical outcomes in the ED can simultaneously reduce service utilization rates of older adults. Emerg Med 42 (Level A): Randomized trials based on results of studies in Emerg Med 41 should be conducted to evaluate the effectiveness of home care in selected older patients.
Resource Allocation	Assess and establish optimal internal and external resources and linkages in the emergency setting to deliver quality palliative and end-of-life care.	Emerg Med 33 (Level C): Prospective studies are needed to evaluate communication between the ED and primary physician, and assess the relation of outcomes to the exchange of information, follow-up interval, and patient satisfaction toward services rendered. Emerg Med 41 (Level B): Randomized trials are needed to assess alternatives to inpatient management of selected conditions in appropriate subsets of acutely ill older adults and to assess optimal candidate selection, patient and caregiver satisfaction scores, cost-effectiveness, mortality, and functional outcomes in varying health care settings.
Education for Clinicians	Establish core competencies and competency evaluation for elements of palliative care. Assessment of the availability and impact of educational programs for ED clinicians.	Section IV: Transitions of Care5 Rapidly establish and document an elder’s goals of care for those with a serious or life-threatening condition and manage accordingly (Element 21). Assess and provide ED management for pain and key non pain symptoms based on the patient’s goals of care (Element 22). Know how to access hospice care and how to manage elders in hospice care while in the ED (Element 23).

AHRQ = Agency for Healthcare Research and Quality.