Wake Forest University School of Medicine
Pragmatic EHR Tool to Identify High-Risk Hospitalized Dementia Patients
Dr. Frechman is an assistant professor at Wake Forest University School of Medicine. She is a board-certified adult gerontological nurse practitioner who specializes in palliative care. Her research is informed by her clinical experiences caring for people living with serious illness across all care settings from the community to the hospital and to long-term care. Dr. Frechman’s research focuses on identifying hospitalized high-risk people living with dementia (PLWD) through an electronic health record risk prediction modeling. She aims to develop transitional care interventions to ensure PLWD and care partners (CPs) are provided needed resources and support. She is committed to improving health and quality of life for PLWD and their CPs through care delivery transformation. Dr. Frechman is seeking to develop skills in applied clinical informatics, pragmatic clinical trial design, and implementation science through this Career Development Award.
Prognostic heterogeneity across the course of dementia places people living with dementia (PLWD) at risk for
acute care utilization, uncertainty in care trajectories, burdensome interventions, and growing demands on care
partners. Pragmatic and accessible prognostic tools may help identify hospitalized PLWD at elevated risk for poor
outcomes and support timelier, goal-informed care. This Career Development Award will provide Dr. Frechman
with training in applied clinical informatics, predictive modeling and risk translation, implementation science, and
the design of embedded pragmatic clinical trials (ePCTs) to support her development as an independent clinician
investigator conducting translational research.
Dr. Frechman will evaluate the prognostic accuracy of the electronic health record (EHR) based End-of-Life Care
Index (EOL-CI) among older adults with dementia or a high likelihood of cognitive impairment and examine the
added value of frailty and other clinical risk factors for predicting mortality. Building on this work, this training will
support the following Specific Aims: (1) evaluate associations between the EOL-CI and adverse clinical outcomes,
burdensome interventions, and the receipt and timing of palliative care among hospitalized older adults with
dementia; and (2) compare these outcomes and patterns of palliative care utilization across hospitalized patients
with dementia and other serious illnesses, including heart failure, chronic obstructive pulmonary disease, end
stage renal disease, and cancer. Together, this work will inform future EHR-integrated, risk-informed interventions
to promote timely, goal-informed care for PLWD and their care partners.