Development and Validation of the Emergency Department Geriatric Readmission Assessment at Yale (ED GRAY): Part 1, Fundamental Measurement.
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Date
2016
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Abstract
Objective: Our primary objective was to develop a reliable, valid, and efficient screening tool that measures recovery disability among geriatric patients for the Department of Emergency Medicine (ED) Geriatric Readmission Assessments (GRAY).
Methods: We conducted a retrospective medical chart review and prospective data analysis of geriatric patients admitted to hospital from the emergency department that were discharged, admitted, or died at a single academic urban university-affiliated hospital to identify items for ED GRAY. Rasch analysis was then used to reduce items and construct an interval/ratio scale of physical and cognitive disabilities. Patients consisted of a cohort of consenting, non-critically ill, English-speaking adults older than 65 years and receiving care in the ED to reduce the number of items.
Results: Rasch analyses resulted in infit and outfit statistics that eliminated redundant items or items that did not fit a unidimensional disability construct. From the 158 original items, sixteen items comprise the ED GRAY global health questionnaire, representing five sub-constructs: physical disability, cognitive disability, stress, depression, and isolation. All infit and outfit statistics for the global recovery disability score ranging from 1 (least healthy) to 5 (most healthy) were consistent with forming a unidimensional scale.
Conclusions: Our study resulted in an objective measurement tool of physical and cognitive disability using Rasch analyses. This screening tool allows healthcare providers the ability to screen older ED patients on a continuum of risk, with high-risk patients being most likely to benefit from in-depth evaluation—e.g., comprehensive geriatric assessment—followed by intervention (when necessary).
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Keywords
Rasch modeling, disability diagnosis, measuring disability, geriatric patients
Citation
Post Lori A. , Conner Thomas L., Oehmke James F., Abujarad Fuad, Cooney Leo M., Brandt Cynthia, Page Connie, Swierenga Sarah, Biroscak Brian J., Esposito Christal, Dziura Jim. Development and Validation of the Emergency Department Geriatric Readmission Assessment at Yale (ED GRAY): Part 1, Fundamental Measurement.British Journal of Medicine and Medical Research. 2016; 14(1): 1-14.