Table 1.
Synthesis of Scoping Review Literature
| PICO-1 | PICO-2 | |
|---|---|---|
|
| ||
| Summary | Population: Adult (≥19-y-old) ED patients from any home (SNF, home, etc) setting with impaired cognition (diagnosed dementia, delirium, positive cognitive impairment screen or noted confusion by the provider) AND/OR their care partner (defined as any individual caring for the patient, whether paid or unpaid). Intervention: Any intervention occurring in the discharge phase of ED care directed at any level (medical system, physician, direct to patient). Comparison: Standard of care as defined by study authors; between individuals with and without impaired cognition. Outcomes: Patient related (eg, quality of life, satisfaction, experience), care partner (eg, satisfaction, experience), utilization (eg, ED revisit, PCP follow-up, hospitalization, cost/medical expenditures). |
Population: Adult (≥19-y-old) ED patients from any home (SNF, home, etc) setting with impaired cognition (diagnosed dementia, delirium, positive cognitive impairment screen or noted confusion by the provider) AND/OR their care partner (defined as any individual caring for the patient, whether paid or unpaid). Intervention: N/A Comparison: Between different types of patient characteristics (eg, race, ethnicity, rural/urban, living arrangement, etc) as well as patients and their care partners. Outcomes: Importance of measures in all domains including patient related (eg, quality of life, satisfaction, experience), care partner (eg, satisfaction, experience), utilization (eg, ED revisit, PCP follow-up, hospitalization, cost/medical expenditures). |
| Number of Included Studies | 7 | 3 |
| Prospective/Retrospective Cohort Study, n (%) | 4 (57) | 1 (33) |
| Randomized/Quasi-Randomized Control Trials, n (%) | 3(43) | N/A |
| Qualitative Analyses, n (%) | N/A | 2 (67) |
| Interventions/Instruments utilized (n) | Medication review (2) Follow-up assessment (6) Initial assessment by geriatrician (5) Care planning (6) Community services (4) |
23 Quality indicators (1) |
| Total number of patients recruited | 3013 | 690 |
| Recruitment period | 2008–2021 | 2015–2020 |
| Geographical locations | 7 countries | 3 countries |
| Mean age range (y) (n) | 78–87 (7) | 80.3–83 (2) Unreported (1) |
| Common inclusion criteria (n) | Age 60 y and older Admitted and eligible for discharge from the ED Scored 2 or higher on senior at risk tool (1) Cognitive impairment (3) |
Age 65 y and older Presenting to the ED (2) Recently discharged from hospital/ED Health care provider directly involved in medication management (1) |
| Patient-centered primary outcomes (n) | Mobility improvements/functional gains (2) Adherence to outpatient follow-up recommendations (1) | N/A |
| ED-centered primary outcomes | Readmission rates within 30 d (6) | NA |
| Secondary outcomes | Length of initial hospital stay (1) Patient satisfaction (1) ED revisits within 14 d (1) Incidences of hospitalization after first admission to ED (2) Mortality (2) |
N/A |
| Follow-up period post-ED discharge | Three d–6 wk | N/A |
| Patient reported measures (n) | N/A | Problems in medication management (1) Feeling overwhelmed (2) Loss of independence (1) Fear of falling (1) Need for screening, risk/pain assessment, medical history, ED length of stay (1) |
| Care partner measures (n) | N/A | Safety and cost of SNFs/long-term care (1) Communication between care partner and care provider (2) Nonspecified (1) |
| Utilization measures | N/A | Follow-up with PCP (1) Referrals for follow-up evaluation of cognitive status (1) |
PCP, primary care physician; SNF, skilled nursing facility.