July 26, 2026
A new article published in the Journal of the American Geriatrics Society describes the results of a recent IMPACT-funded pilot study by Ellen McCreedy, PhD, MPH, and team which tested whether electronic admission, discharge, and transfer notifications could be used to trigger timely care management support when older adults receiving care through an accountable care organization arrive in the emergency department.
The study focused on Bluestone Accountable Care Organization, a national physician group primarily serving assisted living clients. Investigators evaluated the feasibility of pairing real-time electronic notifications with a structured case management response designed to share up-to-date clinical and discharge support information with emergency department providers.
The authors note that providing emergency department teams with timely information about a patient’s baseline function, recent care, outpatient resources, and care team contacts may help support decision-making and reduce avoidable hospitalizations.
The intervention included a structured phone script used by care managers and a one-page faxed form based on established transfer tools. Together, these materials gave emergency department providers information about an individual’s comorbidities, baseline mental and physical function, recent visits and diagnostic results, care team contacts, and available outpatient supports.
The pilot study demonstrated that electronic notifications could alert accountable care organization providers when patients entered the emergency department and could be used to initiate timely care management. Case managers self-reported an 11% hospital diversion rate, though the authors emphasized that a formal efficacy study is needed to validate these findings.
Access the full article here.