ED Disability Diagnostic Tool: An HIT Feasibility Study

Many elderly and disabled patients present to Emergency Departments (EDs) and require an assessment of their disabilities for treatment and proper referral. These patients are disproportionately admitted to the hospital without cause, with a significant proportion experiencing negative health outcomes related to the hospitalization, such as infections, disorientation, and falls due to an unfamiliar environment. ED physicians are often challenged because these patients do not require acute care or hospitalization, yet their failure to thrive in the community brings them repeatedly to the ED, where their needs are often not met.

To improve health and cost outcomes for geriatric patients in the ED, the project team developed, validated, and tested the Rasch Disability Diagnostic Tool (RDDT), a disability screening and prognostic tool. Current disability measures used in long-term care settings to assess functional and cognitive status are unreliable and invalid in the ED. The RDDT uses disability indicators created by research experts and Rasch mathematical modeling techniques to derive a better measure of functional and cognitive disabilities. The tool allows ED physicians to connect patients to better healthcare referrals, proper long-term care services, and other non-ED healthcare providers.

The specific aims of the project were as follows:

• To develop and validate an ED-RDDT. 
• To conduct a randomized controlled trial to evaluate the utility of the ED-RDDT to reduce rehospitalizations in Medicare recipients visiting an urban ED for non-traumatic illness. 

Researchers created the RDDT screening tool for cognitive and physical disabilities for geriatric patients. To validate the tool, disability assessments were linked to patient-oriented outcomes, such as healthcare service utilization and mortality, and RDDT results were compared with those of an existing Measure of Disability (MOD) tool. They also developed a health informatics application that was implemented in a fast-paced, high-volume ED, where the average patient screen took 90 seconds. Investigators are completing the analyses and preparing a publication that describes the cost benefits of identifying cognitive and physical disabilities.