Gary and Mary West Health Institute

Over the course of 2022, the Gary and Mary West Institute (referred to below variously as whi, West Health Institute, or Institute) continued to actively conduct applied medical research, in conjunction with the hospitals listed on schedule a, with the objective of contributing to the body of clinical, scientific, and Health knowledge that can ultimately benefit older adults in america. Our research methodologies encompass a variety of real-world data collection and analysis techniques, and in many cases, we implement programs and structures (e.g., standardized care models, data dashboards, etc.) That allow us to collect systematized research information where little previously existed. These medical research efforts directly supported whi's mission of lowering the cost of healthcare and enabling seniors to successfully age in place with access to high-quality, affordable Health and support services that preserve and protect their dignity, quality of life and independence. Our major workstreams for 2022 broadly fit into the areas of (senior appropriate) acute care research, chronic care research, and telehealth research and are described below. Senior-appropriate acute care research in 2022, the Institute continued to expand its research portfolio and grow the body of evidence for new strategies in acute care. Unplanned (acute) needs remain the primary driver of costs for the nation's vulnerable older adults, as well as leading to lasting detrimental effects (e.g., post-visit debilitation and functional decline). Success in this area is essential to achieving better, more affordable outcomes for older adults. Acute care research area: geriatric emergency departments (geds):ged heatmap: developing tools to increase scope of collaborative work with stakeholders geriatric emergency departments are a resource that, ideally, should expand to meet the needs of america's steadily growing older adult population. In order to chart the spread of accredited geriatric emergency departments at us hospitals, the Institute is internally developing an instrument that quantifies where access is needed and focuses on high-risk sites. This tool consists of eligible acute care facilities, population- level data and existing accredited sites. This interactive "heatmap" is being engineered to examine the distribution of ged's across the country and assess the need for adoption. For collaborators, this heatmap can target which areas indicate potential future sites for accreditation. For researchers, this evidence-based tool can help with studying scalability. Ged dashboard: giving geds a tool to track progress:geds need data to drive their own decision-making and inform on-going process improvements. Whi has developed and hosts a dashboard for participating geds that enables them to track their progress over time against their own goals. The Institute has collected aggregate level data from piloting emergency departments and begun testing the platform to determine usability and alignment to strategic goals for emergency department leaders.examining the differences in the cost of care for ged patients:the university of California san diego (ucsd) hospital Health collaboration has proven to be a successful partnership as they paved the way for all uc Health systems in California to achieve ged accreditation with whi support. This year, to illustrate the value of geds to internal and external stakeholders, the Institute collaborated with ucsd in conducting a costing study to assess differences in the cost of care for patients who received ged services versus those who did not receive ged services. Once the study was finalized, it was presented at the american college of emergency physicians (acep) scientific assembly in october 2022. The costing study informed the development of a plan to address long-term sustainability of the ged program at ucsd and as a model for other geds. The Institute provided advisory support to ucsd regarding the analysis, supported the interpretation of results, and co-authorship of paper. Sharing lessons learned and a glance into rural healthcare:this year the Institute worked closely with dartmouth hitchcock medical center hospital (dhmc) to evaluate and disseminate learnings from their ged implementation. Additionally, whi organized virtual site visits with critical access hospitals and learned about the barriers in care provision for their older adult populations. With this and additional feedback from dhmc, we codified and documented guidelines for use of telehealth in the ed for rural hospitals. Two papers were authored jointly by dhmc and whi on ed transitions of care and patient experience, illustrating the care provided to older adult patients in rural new hampshire by dhmc. Whi and dhmc also created a 'lessons learned' brief and a business case study that incorporates information and recommendations about spreading ged accreditation in rural area hospitals based on the dhmc experience and approach. Engaging with multidisciplinary research stakeholders:whi developed, hosted, and managed a research data warehouse (rdw) to act as a multi-site ged data depository. The rdw contained limited datasets from 17 different ged hospitals to facilitate multisite research on geriatric emergency medicine. Several research plans to use this data were developed with external collaborators. Whi also reviewed research funding applications for use of the rdw through pilot grants.whi reviewed several draft manuscripts developed by yale school of medicine and gedc subcontractors that assessed outcomes of older adults in eds. Additionally, the Institute developed a logic model for geds with support of gedc experts for dissemination to the broader research community. The logic models provide a visual framework of the program for those seeking to identify potential research questions and leverage points for intervention. Whi presented at the acep annual conference regarding the research data warehouse. Capturing sites across san diego county (acep):in collaboration with whi, the american college of emergency physicians (acep) successfully orchestrated a county-wide accreditation program resulting in all hospital sites in san diego to obtain between level 1, 2, or 3 ged accreditation. Whi sat in on working groups to develop key indicators for reporting for accredited sites and explored the possibility of leveraging their clinical emergency data registry data as input for dashboard and qi data. Additionally utilizing this data leverages acep/geda applications to inform research studies. Using standardized methods for future research opportunities (va):with more than 200 accredited geds, several protocols were set in place to position whi and the department of veteran affairs (va) for future research. Whi supported the development and implementation of standardized interventions and metrics that are captured in a national dashboard that provides real-time information on ed utilization and geriatric screenings in va hospitals (geds and non geds). This implementation was used in a descriptive abstract presented by the va at the acep scientific assembly in october 2022.pilot testing a toolkit to enable aligned partnerships between geds and value-based care organizations:research shows geds contribute to reduced hospital admissions, fewer readmissions and savings of $1,200 - $3,200 per medicare beneficiary within 60 days of the index ed visit. A major focus of value-based care organizations (vbcos) is reducing avoidable hospital admissions and they typically have the financial and quality incentives to provide care best matched to the needs of their beneficiaries. For these reasons and more, we believe there are great opportunities to investigate improved care and lower cost for older adults by fostering meaningful vcbo/ged research partnerships.in 2022, we launched a successful research collaboration with four Health system hospital geds including advocate aurora (Wisconsin), st joseph's Health (new jersey), and the university of north carolina Health system, to cultivate partnerships with vbcos (accountable care organizations, clinically integrated networks, and pace) whose patients were being seen in the geds. Communication and quality improvement activities were investigated using a whi developed "toolkit" as a guide.

Cost of healthcare:older adults in america (and indeed all individuals residing in this nation) continue to feel the economic burden of what are among the highest healthcare costs in the world. High healthcare costs threaten financial security, curb patient access, and crowd out spending in other important economic sectors such as education and social services. The Gary and Mary West Health Institute (whi or Institute) remains committed to playing an important role in conducting applied medical research to help provide unbiased and reliable data and findings that enable stakeholders in the us Health system chart a course to healthcare that is more affordable and ultimately a better value for older adults in america.the West Health Institute's areas of focus in addressing the cost of healthcare over the past year have been centered around conducting research and sharing statistics that can be used in raising awareness about the size and urgency of this issue, lowering prescription drug prices, and increasing price transparency with a goal of highlighting, and eventually enabling the reduction of, out-of-control healthcare service pricing.generate data that highlights to the nature and magnitude of the Health spending crisis:to focus the attention of policymakers, administrators, and the general public on the healthcare crisis, whi undertook a variety of key public and policymaker education and awareness strategies in 2022. We collaborated on public polling activities at the state and national level with gallup and others. As a result of this work, we prepared five articles related to quantifying and dimensionalizing americans' growing struggle to pay for healthcare and tradeoffs they are making to afford care. Two new composite indices were also created as part of this polling/awareness work: the West health-gallup healthcare affordability index and healthcare value index. The healthcare affordability index assesses the public's ability to afford the healthcare they need, while the healthcare value index synthesizes americans' perceptions of the quality of care relative to cost. Continue to develop understanding of governmental healthcare cost issues at the national level:whi continued to work with several consultants to ensure that the Institute's work remained germane and supportive of our mission. We worked with these consultants to:1. Provide technical expertise and analysis of new and emerging policies from the administration, as well as what research and/or data products may contribute towards policies addressing healthcare costs and successful aging2. Provide clarity and explanations on legislative activities and trends, as well as what research and/or data products may contribute towards policies addressing healthcare costs and successful aging3. Provide insights around policy-related activities of other organizations with similar missionssupport for the California master plan for aging:the master plan for aging (mpa) in California is a blueprint for state and local government, the private sector, and philanthropy to prepare the state for the projected demographic changes and amplify California's leadership in aging, disability, and equity. Throughout 2022, whi continued to provide science-driven input into the mpa in a number of ways. In addition to the geriatric emergency department (ged) research workstream which continues to support the ged objectives now specifically called out in the mpa, the Institute has continued to improve and support the data dashboard for aging, which tracks the master plan's targets currently and over ten years. The data dashboard was co-developed by the California departments of aging and public Health and the West Health Institute which showcases how research and data can be used to both inform and evaluate policy decisions at a macro level.