Despite the fact that older adults account for 1 in 5 U.S. ED visits, there were no geriatric emergency medicine-focused quality measures tied to federal reporting and payment programs prior to 2022. We sought to develop the first geriatric EM quality measure measuring prescription safety based on evidence of persistent high-risk ED prescribing practices and successful ED quality improvement interventions to reduce high-risk prescribing. However, most high-risk geriatric prescription lists were not developed with the Emergency Department in mind, where minimizing prescriptions with the highest risk of short-term harm is of highest priority. We convened an expert panel to prioritize a list of high-risk ED prescriptions to avoid among patients age 65 and older and are proud that the quality measure was recently approved for use by CMS.

Bios: 

Dr. Lin: Dr. Lin is an Associate Professor of Emergency Medicine whose work is driven by a strong belief that emergency departments can be a key partner in improving care for older adults—in particular, for those who experience barriers to accessing care in other settings due to adverse social and functional factors. Her projects seek to understand how acute care delivery innovations can reduce hospitalizations, enhance care coordination, and improve patient-centered outcomes for older adults. Dr. Lin has received funding from the Stanford Alzheimer’s Disease Research center to evaluate disparities in access to Geriatric Emergency Department Accreditation among structurally marginalized populations. She led the development of the first ED-focused geriatric prescription safety quality measure in her leadership role overseeing national quality measure development for the Clinical Emergency Data Registry and American College of Emergency Physicians. Her NIH-funded research portfolio aims to validate a novel patient-reported outcome measure for emergency care and evaluate the impact of value-based care on emergency care delivery and payment. She was previously a fellow at the Centers for Medicare and Medicaid Innovation evaluating access to care among Medicare beneficiaries enrolled in advanced alternative payment models.

Dr. Skains: Rachel Michelle Skains, MD, MSPH is an Assistant Professor in the Department of Emergency Medicine (EM) at the University of Alabama at Birmingham (UAB) with a joint faculty position at the Birmingham VA Medical Center (BVAMC). Dr. Skains is an early-stage investigator focused on improving the acute care of older adults through patient-centered outcomes research. After graduating from Wake Forest School of Medicine (2016), she completed her EM residency at UAB (2019) followed by a Clinical Research Fellowship focused on Geriatric EM while pursuing a Master of Science in Public Health (MSPH) in Clinical and Translational Science from the UAB School of Public Health (2021). Dr. Skains was awarded the AHRQ NRSA T32 Postdoctoral Scholar Fellowship (2020-2022), in addition to funding through the UAB Integrative Center for Aging Research (ICAR) and Geriatric Emergency care Applied Research (GEAR) 1.0 pilot grant programs. She has recently been awarded two NIA awards: Grants for Early Medical/Surgical Specialists' Transition to Aging Research (GEMSSTAR) R03 (2023-2025) and Exploratory/ Developmental Grant R21 (2023-2025). Furthermore, Dr. Skains is a physician champion for the UAB – Highlands and BVAMC Geriatric ED Committees, which received Level 1 (2021) and Level 3 (2023) accreditations respectively, completed the UAB Geriatric Scholar Interprofessional Program (2019-2021), and served as Fellow board member for the GEM Section of ACEP (2021-2023) and currently Chair of the AGEM Grants & Awards Subcommittee (2023-Present). Dr. Skains is also leader of the Medication Safety Committee to update the national Geriatric ED Guidelines 2.0, leader of the CMS quality measure for geriatric high-risk ED prescriptions expert consensus group, and was awarded the 2023 SAEM AGEM Early Career Achievement Award.