Redesigning Acute Care for Seniors

In August 2019, guest speakers from West Health presented Medicine Grand Rounds at Dartmouth-Hitchcock Medical Center. From left to right: Tim Lash, chief strategy officer and executive vice president of West Health and president of West Health Policy Center; Shelley Lyford, president and chief executive officer of West Health, the Gary and Mary West Foundation, and the West Health Institute; and Kevin Biese, MD, co-director of the Division of Geriatrics Emergency Medicine at the University of North Carolina at Chapel Hill School of Medicine and West Health consultant. Photo by Lars Blackmore

West Health Awards $3M to Dartmouth-Hitchcock for Partnered Project

Emergency care sits at the crossroads of health care. As the U.S. population ages, more older adults are turning to emergency departments (EDs) for their health care needs. EDs must be equipped not only to deal with acute medical emergencies but also to coordinate care, avoid admissions when possible, provide patients with support, and connect them to community partners—all in an ED environment designed with the needs of seniors in mind. Designing a “Geriatric ED” (GED) with protocols, resources, and even specialized care areas has been recognized as an important strategy to optimize the acute care of older adults, yet many of the hospitals implementing GEDs have been urban academic medical centers.

By contrast, rural sites—and the largely rural setting of Northern New England in particular—offer unique challenges to implementing improved acute care for the growing geriatric population. Northern New England is one of the United States’ most rapidly aging regions, with Vermont and New Hampshire being the second and third oldest states respectively by median age. Older adults who live in poverty are significantly more likely to live in rural areas. Limited access to services, workforce shortages, social isolation, and transportation problems are particularly severe in these remote regions. Caring for older adults in rural areas such as Northern New England requires innovations in the delivery of geriatric emergency medicine. 

It’s another step forward in D-H’s vision to improve access to high-quality health care for all people, regardless of where they live.

West Health—a family of nonprofit and nonpartisan organizations dedicated to lowering health care costs to enable seniors to successfully age in place—has chosen to partner with Dartmouth-Hitchcock (D-H) to address this gap in rural geriatric emergency medicine. Over the course of a three-year research collaboration, the West Health Institute will contribute expertise and $3 million in capital to establish Dartmouth-Hitchcock Medical Center (DHMC) as a Center of Excellence in geriatric emergency care. After DHMC earns accreditation as a top-tier, level 1 GED “hub,” its specialized services will be offered to four “spoke” sites through telemedicine. D-H has committed an additional $1.5 million to the overall project cost.

Geriatric Emergency Telecare

Ultimately, this project will demonstrate the effectiveness and sustainability of using telemedicine to extend the reach of a GED to rural hospitals, as well as investigate the opportunities for scaling this concept to other rural facilities across Northern New England—and throughout the country.

Scott Rodi, MD, interim section chief and regional director of emergency medicine at DHMC, associate professor at Geisel, and principal investigator for this collaboration, says, “Seniors who seek treatment in EDs are often highly complex patients with various medical and social issues that are challenging for any ED, and can be especially challenging for rural hospitals with fewer resources. This partnership with West Health will enable D-H to work with our rural colleagues to provide specialized senior-specific care to more patients throughout the region. It’s another step forward in D-H’s vision to improve access to high-quality health care for all people, regardless of where they live.”

“This is the perfect union,” says Shelley Lyford, president and chief executive officer of West Health. “Combining West Health’s experience in geriatric care with Dartmouth-Hitchcock’s pioneering work in telehealth and geriatrics will enable D-H to add geriatric emergency telecare to its already world-class telehealth portfolio. And seniors will be the beneficiaries of this important work.”

By Laura Seidman