Emergency Department Care Coordination Program for Assisted Living Residents With Dementia: A Qualitative Study

Area of Science:

• Gerontology
• Health Services Research
• Quality Improvement

Background:

• Care transitions from assisted living centers (ALCs) to emergency departments (EDs) are challenging, often involving incomplete information transfer.
• Vulnerable populations, including persons living with dementia (PLWD), face particular difficulties during these transitions.

Purpose of the Study:

• To evaluate complex care managers' (CCMs) perceptions of a care coordination program designed to improve communication during ALC-to-ED transfers.
• To identify strengths and weaknesses of the program from the CCMs' perspective.

Main Methods:

• A qualitative study involving semistructured video conference interviews with 12 CCMs in February 2024.
• The study analyzed data using directed content analysis in March and April 2024.
• The program involved electronic notification to CCMs upon patient ED registration, followed by information exchange with ED staff via fax and phone.

Main Results:

• CCMs perceived the program as beneficial for PLWD, hospice patients, and group home residents.
• Strengths included CCM patient advocacy and program adaptability; weaknesses involved limited ED staff awareness and lack of 24-hour CCM coverage.
• Receptivity to communication varied among ED nurses and physicians.

Conclusions:

• CCMs effectively advocated for patients remotely, filling information gaps and improving care, particularly for PLWD.
• The intervention was perceived to positively impact the ED experience and facilitate goal-concordant care.
• Key areas for enhancement include increasing ED staff awareness and expanding program operating hours to address care gaps for ALC residents presenting to the ED.