GAPcare II: The Geriatric Acute & Post-acute Care Coordination Program for Fall Prevention in the Emergency Department

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PROJECT SUMMARY Before the COVID-19 pandemic, only 4% of older adults used telehealth, but uptake has been rapid since the start of social distancing. However, little is known about physicians’ experiences implementing telehealth or the extent of uptake among US physicians. There is a critical need to disseminate useful telehealth strategies that physicians have employed to treat older adults, especially those with disabilities (e.g. visual, hearing, mobility, cognitive), living in facilities, with limited digital know-how or access to technology. Through in- depth interviews with geriatricians, primary care, and emergency physicians, who are the first point of contact during COVID-19, and a subsequent national survey, we propose revealing these strategies, understanding the scope of telehealth uptake nationally, and disseminating our insights which could inform healthcare delivery transformation for older adults. The rationale that underlies the proposed research is that physicians have made important discoveries about telehealth since the start of COVID-19 and disseminating lessons learned will ensure that older adult needs are considered as care is rapidly shifted to the virtual environment. Without attention to equity and leveraging insights of physicians that care for older adults, the “digital divide” will cause already existing inequities in medical care to further increase at the expense of older adults. Identifying where telehealth has not yet been implemented can be helpful to focus awareness efforts. Dr. Goldberg will pursue the following two specific aims: (1) conduct semi-structured telephone interviews (n=36-54) with geriatricians, primary care and emergency physicians (n=12-18 each), stratified by practice setting (metro/suburban/rural (n=12-18 each)) and type (academic/community (n=18-27 each)) to explore telehealth services provided/abandoned, modes of use, facilitators/barriers, practical considerations, and experiences with providing care remotely to older adults. We will solicit physicians on social media platforms (Twitter, Facebook), and via specialty society listserves. Findings will inform item generation, reduction, and question content for the survey; (2) conduct a web-based national survey of geriatricians, primary care and emergency physicians (n=1,600, 1% of each specialty) using the American Medical Association’s Physician Masterfile to estimate the scope of telehealth use, methods of delivery, barriers/challenges to adoption, and lessons learned delivering care to older adults. This contribution is expected to be significant because the choices physicians make in adapting their clinical practice to the remote environment - what modes to use, how to train and assess patients - are likely to dictate if older adults’ needs and challenges are considered as the future of healthcare delivery takes shape. Dr. Goldberg’s overarching aims are to ensure older adults receive medical care in the most suitable setting by enhancing the knowledge and training physicians receive in telehealth to meet the unique needs of their patients during and after the pandemic. The completion of these aims will provide Dr. Goldberg with critical pilot data for a telehealth training RCT which will be submitted as a R01 to the NIA.