Growing the Geriatric Emergency care Applied Research (GEAR 1.1) network: Expanding and sustaining an emergency care aging study infrastructure.

PROJECT ABSTRACT: A more robust research infrastructure is urgently needed to develop and test best practices in the emergency department (ED) setting that address the medical, health, and psychosocial needs of older patients and persons living with dementia (PLWD). The aging population and utilization of emergency care combine to create an opportunity in the care continuum to detect and change patient care trajectories and underscore the urgency to identify and disseminate best practices in geriatrics and dementia emergency care. Unfortunately, due to the lack of infrastructure, there is a paucity of research to guide this work. The field is limited by lack of standardization and few estimates of effectiveness of interventions and geriatric care delivered at facilities that report Geriatric Emergency Department (GED) programs. We have built and designed an early research infrastructure, the Geriatric Emergency care Applied Research (GEAR) network to meet this critical need. GEAR is a growing network of health systems with GEDs, transdisciplinary researchers, and content experts that have created a multicenter database and pilot study opportunities focused on aging studies in geriatric and dementia emergency care. We will grow the Geriatric Emergency care Applied Research (GEAR 1.1) network by expanding and leveraging the research data infrastructure established during its first phase, going from 4 to 7 health systems, from 6 to 47 hospitals, representing over 2.2M ED encounters made by over 684K unique patients. The GEAR 1.1 Ecosystem will be available to the general research community, supporting efficient access to and use of large, multicenter datasets for the conduct of geriatric and dementia-related emergency care aging studies, including the ability to focus on health disparities. Specifically, we will: (1) Increase the number of sites and data capabilities of GEAR, (2) Coordinate data harmonization and data linkage development across multiple sites including NIA LINKAGE between Medicare and GEAR 1.1 data, and (3) Conduct multicenter evaluations, including small-scale pilot studies that leverage the GEAR Ecosystem to address research gaps identified by GEAR priority populations. We will expand and build upon an early platform from which GEAR and future investigators will be able to generate and use the data for multicenter projects, conduct larger scale observational studies, and emulate multicenter clinical trials. This will grow intra- and inter-networks both within and across participating healthcare systems promoting the spread and partnerships of transdisciplinary aging studies and sciences. Now that the initial GEAR network has laid the groundwork, GEAR 1.1 will solidify the foundation to create a more mature and sustainable research infrastructure to support the development of an evidence-base for high-quality geriatric and dementia emergency care.