Dartmouth-Hitchcock, West Health to create rural geriatric ED

As the U.S. population ages, older adults are turning to emergency departments (EDs) for their health care needs. In response, EDs must be equipped not only to deal with acute medical emergencies, but also to coordinate care, avoid admissions when possible, provide patients with support, and connect them to community partners through an ED environment designed with the needs of seniors in mind.

Dartmouth-Hitchcock Health (D-HH) will partner with West Health–a family of nonprofit and nonpartisan organizations dedicated to lowering health care costs to enable seniors to successfully age in place–in a $4.5 million research collaboration to create an innovative “Geriatric Emergency Department” (GED). The GED is designed with protocols, resources, and specialized care areas to optimize the acute care of older adults. While most hospitals implementing GEDs have been urban or larger academic medical centers, the D-HH/West Health collaboration will be the first in the nation to focus on a largely rural population.

“Improving the delivery of care in rural areas is one of the strategic imperatives for Dartmouth-Hitchcock Health, as we grow to meet the needs of patients around the region,” said D-HH CEO and President Joanne M. Conroy, MD. “With our strong programs and passionate providers in Emergency Medicine and Geriatrics, along with our dynamic Connected Care Center, we are uniquely qualified for the development of a rural telehealth model of geriatric emergency care that this collaboration will enable.”

“This is the perfect union,” says Shelley Lyford, president and chief executive officer of West Health. “Combining West Health’s experience in geriatric care with Dartmouth-Hitchcock’s pioneering work in telehealth and geriatrics will enable D-H to add geriatric emergency telecare to its already world-class telehealth portfolio. And seniors will be the beneficiaries of this important work.”

Over the course of the three-year research collaboration, the West Health Institute will contribute expertise and $3 million in capital to establish Dartmouth-Hitchcock Medical Center in Lebanon (DHMC) as a center for geriatric emergency care. The collaboration will develop and implement protocols, resources, and specialized care areas within the Emergency Department at DHMC, all to optimize the acute care of older adults.

After DHMC earns accreditation from the American College of Emergency Physicians (ACEP) as a top-tier, Level 1 GED, its specialized services will be offered with DHMC as the “hub” to four “spoke” sites around the region through D-HH’s Center for Telehealth. D-HH has committed an additional $1.5 million to the overall project cost.

“Seniors who seek treatment in EDs are often highly complex patients with various medical and social issues that are challenging for any ED, and can be especially challenging for rural hospitals with fewer resources,” says Scott Rodi, MD, interim section chief and regional director of emergency medicine at DHMC. “This partnership with West Health will enable us to work with our rural colleagues to provide specialized, senior-specific care to more patients throughout the region. It’s another step forward in our vision to improve access to high-quality health care for all people, regardless of where they live.”

The largely rural setting of Northern New England offers unique obstacles to implementing improved acute care for the growing population of senior adults. Northern New England is one of the United States’ most rapidly aging regions, with Vermont and New Hampshire being the second- and third-oldest states, respectively, by median age. Older adults who live in poverty are significantly more likely to live in rural areas. Limited access to health services, workforce shortages, social isolation, and transportation problems are particularly severe in these remote regions. Caring for older adults in rural areas such as Northern New England requires innovation in geriatric emergency medicine.

Ultimately, this collaboration will evaluate the effectiveness and sustainability of using telemedicine to extend the reach of a GED to rural hospitals, and create opportunities to scale the concept to other rural facilities across Northern New England and throughout the country.

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