Abdominal Pain in Older Patients in Emergency Departments

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PROJECT SUMMARY/ABSTRACT Candidate: Ari B. Friedman, MD, PhD is junior faculty at the University of Pennsylvania (Penn). He practices clinically as an emergency physician and conducts research as a health economist into how care systems affect patients' lives. He is passionate about improving the care and outcomes of the many older patients that he sees in the emergency department (ED) by improving the science underlying that care. Goal: The purpose of this K23 Career Development Award is to enable Dr. Friedman to gain knowledge and skills necessary to become an independent investigator focusing on the emergent care of older patients. Research Context: Visits to hospital EDs are a growing source of care for adults over 65, totaling 22.4 million visits in 2017. Among older patients, abdominal pain is the single most common chief complaint. Simply being over 65 years, presenting to an ED, and stating at triage, “I have abdominal pain,” as a chief complaint confers a mortality rate as high or higher than an ST-Elevation Myocardial Infarction (STEMI), with equivalently high morbidity. Yet little is known about this phenomenon, especially for patients with frailty or cognitive impairment. Career Development Plan: Dr. Friedman seeks training in frailty, cognitive impairment and dementia, geriatrics, primary data collection, and health disparities. This award will provide protected time for Dr. Friedman to acquire the skills necessary to secure independent funding through a progressive, milestone- driven training plan that includes coursework, mentored research, and guided independent study. Aims: The central hypothesis of this proposal is that there are identifiable ways to improve the evaluation and management of abdominal pain among older patients in the ED. Dr. Friedman will use the training funded by this Mentored Patient-Oriented Research Career Development Award to examine variation in ED abdominal pain testing, management, disposition, and outcomes overall and among patients with frailty, cognitive impairment, among disadvantaged populations, and in periods when resources do not meet demand. Research Plan: These Aims will be carried out by using primary data collected through the proposed ED Geriatric Abdominal Pain (ED-GAP) cohort with additional variables from the Penn Electronic Health Record (EHR). This data will capture both management and outcomes for admitted patients and contains measurements of essential factors associated with aging. Retrospective EHR data of abdominal pain visits to 6 EDs over 8 years will also be used. Multivariate regression will test the hypotheses above. Environment: Senior researchers with an established track record of mentoring scholars from their early career to independent and impactful work are committed to Dr. Friedman's success. This team is embedded within a university environment with a track record of collaborative, pathbreaking scholarship in health economics, health services research, emergency medicine, and gerontology.