{"doi":"10.1111/acem.14732","title":"Care transition outcome measures of importance after emergency care: Do emergency clinicians and older adults agree?","abstract":"Emergency department (ED)-to-community care transitions represent a time of substantial vulnerability for older adults, with an increased risk of ED revisits, hospitalization, and mortality.1 Historically, researchers and policymakers have focused on health care utilization outcomes for evaluation given their relative ease of capture. However, the assessment of patient-reported outcome measures (PROMs) has gained momentum and may be of particular value for the geriatric emergency medicine (EM) population, which has unique perspectives and priorities in comparison to younger patients.2, 3 Older adults are increasingly prioritizing PROMs (e.g., functional status, quality of life) during and after ED visits.4 To what extent older adults and clinicians prioritize similar outcomes following an ED visit is unknown. Discrepancies between priorities may result in older patients receiving misaligned ED care and inadequate guidance regarding the subsequent expected course. We sought to determine the degree to which older adults and EM clinicians agree on which topics relevant to care transitions should be assessed following ED visits. This cross-sectional analysis identifies the degree of agreement in the importance of survey items between cognitively intact older adults and expert clinicians and is part of a larger ongoing study to develop and validate the novel Patient-Reported Outcome Measure–Older adult care Transitions from the Emergency Department (PROM-OTED) tool. This study protocol was approved by the Yale University Institutional Review Board. We recruited older adults from four hospital EDs: one Level I trauma center/tertiary referral hospital, two academic community hospitals, and one freestanding ED. Inclusion criteria for patients were: (1) age 65 or older, (2) discharged after the ED encounter, (3) community-dwelling (excluding residents of nursing homes or other extended care facilities), (4) cognitively intact as determined by validated ED screening tools,5 and (5) fluent in English or Spanish. We chose to include five expert clinicians as five to seven clinicians has historically been considered a best practice for completing content validity assessments in PROM development, which we concurrently performed.6 The team of expert clinicians was selected based on serving as leaders in the fields of geriatric emergency medicine or nursing, care transitions, outcome measurement, and survey tool design. We generated a list of 47 candidate items through two primary mechanisms: (1) assessment and adaptation of available PROMs (e.g., AQoL-8D, CTM-15) within existing databases that span health care settings and (2) translation of recognized barriers experienced by older adults during ED-to-community care transitions.7 The lead author grouped the candidate items into four domains: discharge process (13 items), care transition (12 items), symptoms and quality of life (10 items), and functional status and disability (12 items). An example candidate item in the discharge process domain was: “When I left the ED, I clearly understood the warning signs and symptoms I should watch for to monitor my health condition.” A list of all candidate items is provided in Table S1. Aligned with prior literature sample sizes,8 we purposively sampled and enrolled 50 older adults while in the four EDs to determine the importance of each candidate item for inclusion on the final PROM-OTED tool. We provided older adults with a description of the domain's intent and instructions to, “Please rank each of the following questions/statements based on how important you think they are to ask after the emergency department (ED) visit.” Responses were on a 5-point Likert scale, ranging from 1 being “not important” and 5 being “very important.” Each participant received a $25 gift card after completion. Expert clinicians were given similar instructions to respond regarding the importance of asking older adults each of the candidate items during ED-to-community ca","journal":"Academic Emergency Medicine","year":2023,"id":374519,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9548,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":856604,"name":"Ula Hwang","orcid":"0000-0002-3715-3073","position":1,"is_corresponding":false},{"id":685286,"name":"Kristin L. Rising","orcid":"0000-0003-3882-4956","position":2,"is_corresponding":false},{"id":662942,"name":"Elizabeth M. Goldberg","orcid":"0000-0003-1817-0705","position":3,"is_corresponding":false},{"id":514428,"name":"Shelli L. Feder","orcid":"0000-0002-8059-9281","position":4,"is_corresponding":false},{"id":961966,"name":"Ivie Uzamere","orcid":null,"position":5,"is_corresponding":false},{"id":413443,"name":"Arjun K. Venkatesh","orcid":"0000-0002-8248-0567","position":6,"is_corresponding":false},{"id":662940,"name":"Cameron J. Gettel","orcid":"0000-0002-6249-1023","position":0,"is_corresponding":true}],"reference_count":9,"raw_metadata":null,"created_at":"2026-07-19T01:16:15.380731Z","pmid":"37014286","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}