About

Manish N. Shah, MD, MPH, is the Chair of the BerbeeWalsh Department of Emergency Medicine at the University of Wisconsin School of Medicine and Public Health, where he also serves as a professor of emergency medicine, population health sciences, and geriatrics. His career as a clinician, researcher, and educator is dedicated to improving prehospital and emergency department care for acutely ill older adults, particularly those living with dementia. His work focuses on developing, testing, and implementing innovative approaches to provide safe, convenient, and effective acute illness care for older adults. Dr. Shah has played a pioneering role in establishing the field of geriatric emergency medicine and advancing the role of ambulance-based paramedics in community health efforts, known as community paramedicine. Throughout his career, he has authored over 175 publications and secured more than $150 million in grants and contracts as a principal or co-investigator. In recent years, his efforts have also concentrated on training and mentoring the next generation of emergency medicine researchers and faculty, many of whom have gone on to successful careers in academic emergency medicine.

Research topics

• Medicine
• Medical emergency
• Nursing
• Psychiatry
• Gerontology
• Emergency medicine
• Internal medicine
• Psychology
• Chemistry
• Biology
• Bioinformatics
• Physical therapy
• Pathology

Selected publications

• Improving Older Adult Care Transitions, from the Emergency Department to Home: The Community Paramedic Transitions Intervention

  Springer eBooks · 2024

  Senior authorCorresponding
  • Medicine
  • Medical emergency
  • Nursing
  PublisherDOI

• Emergency Department Communication in Persons Living With Dementia and Care Partners: A Scoping Review

  Journal of the American Medical Directors Association · 2022 · 45 citations

  • Medicine
  • Medical emergency
  • Gerontology
  PublisherOA PDFDOI

• Emergency Department Care Transitions for Patients With Cognitive Impairment: A Scoping Review

  Journal of the American Medical Directors Association · 2022 · 66 citations

  • Medicine
  • Medical emergency
  • Gerontology

  OBJECTIVES: We aimed to describe emergency department (ED) care transition interventions delivered to older adults with cognitive impairment, identify relevant patient-centered outcomes, and determine priority research areas for future investigation. DESIGN: Systematic scoping review. SETTING AND PARTICIPANTS: ED patients with cognitive impairment and/or their care partners. METHODS: Informed by the clinical questions, we conducted systematic electronic searches of medical research databases for relevant publications following published guidelines. The results were presented to a stakeholder group representing ED-based and non-ED-based clinicians, individuals living with cognitive impairment, care partners, and advocacy organizations. After discussion, they voted on potential research areas to prioritize for future investigations. RESULTS: From 3848 publications identified, 78 eligible studies underwent full text review, and 10 articles were abstracted. Common ED-to-community care transition interventions for older adults with cognitive impairment included interdisciplinary geriatric assessments, home visits from medical personnel, and telephone follow-ups. Intervention effects were mixed, with improvements observed in 30-day ED revisit rates but most largely ineffective at promoting connections to outpatient care or improving secondary outcomes such as physical function. Outcomes identified as important to adults with cognitive impairment and their care partners included care coordination between providers and inclusion of care partners in care management within the ED setting. The highest priority research area for future investigation identified by stakeholders was identifying strategies to tailor ED-to-community care transitions for adults living with cognitive impairment complicated by other vulnerabilities such as social isolation or economic disadvantage. CONCLUSIONS AND IMPLICATIONS: This scoping review identified key gaps in ED-to-community care transition interventions delivered to older adults with cognitive impairment. Combined with a stakeholder assessment and prioritization, it identified relevant patient-centered outcomes and clarifies priority areas for future investigation to improve ED care for individuals with impaired cognition, an area of critical need given the current population trends.

  PublisherOA PDFDOI

• Optimal Emergency Department Care Practices for Persons Living With Dementia: A Scoping Review

  Journal of the American Medical Directors Association · 2022 · 53 citations

  • Medicine
  • Gerontology
  • Medical emergency
  PublisherOA PDFDOI

• Effectiveness of a care transitions intervention for older adults discharged home from the emergency department: A randomized controlled trial

  Academic Emergency Medicine · 2021 · 27 citations

  Senior authorCorresponding
  • Medicine
  • Emergency medicine
  • Physical therapy

  BACKGROUND: Improving care transitions following emergency department (ED) visits may reduce post-ED adverse events among older adults (e.g., ED revisits, decreased function). The Care Transitions Intervention (CTI) improves hospital-to-home transitions; however, its effectiveness at improving post-ED outcomes is unknown. We tested the effectiveness of the CTI with community-dwelling older adult ED patients, hypothesizing that it would reduce revisits and increase performance of self-management behaviors during the 30 days following discharge. METHODS: We conducted a randomized controlled trial among patients age ≥ 60 discharged home from one of three EDs in two states. Intervention participants received a minimally modified CTI, with a home visit 24 to 72 h postdischarge and one to three phone calls over 28 days. We collected demographic, health status, and psychosocial data at the initial ED visit. Medication adherence and knowledge of red flag symptoms were assessed via phone survey. Care use and comorbidities were abstracted from medical records. We performed multivariate regressions for intention-to-treat and per-protocol (PP) analyses. RESULTS: Participant characteristics (N = 1,756) were similar across groups: mean age 72.4 ± 8.6 years and 53% female. Of those randomized to the intervention, 84% completed the home visit. Overall, 12.4% of participants returned to the ED within 30 days. The CTI did not significantly affect odds of 30-day ED revisits (adjusted odds ratio [AOR] = 0.97, 95% confidence interval [CI] = 0.72 to 1.30) or medication adherence (AOR = 0.89, 95% CI = 0.60 to 1.32). Participants receiving the CTI (PP) had increased odds of in-person follow-up with outpatient clinicians during the week following discharge (AOR = 1.24, 95% CI = 1.01 to 1.51) and recalling at least one red flag from ED discharge instructions (AOR = 1.34 95% CI = 1.05 to 1.71). CONCLUSIONS: The CTI did not reduce 30-day ED revisits but did significantly increase key care transition behaviors (outpatient follow-up, red flag knowledge). Additional research is needed to explore if patients with different conditions benefit more from the CTI and whether decreasing ED revisits is the most appropriate outcome for all older adults.

  PublisherOA PDFDOI

• Delirium Prevention, Detection, and Treatment in Emergency Medicine Settings: A Geriatric Emergency Care Applied Research (GEAR) Network Scoping Review and Consensus Statement

  Academic Emergency Medicine · 2020 · 102 citations

  • Medicine
  • Medical emergency
  • Nursing

  BACKGROUND: Older adult delirium is often unrecognized in the emergency department (ED), yet the most compelling research questions to overcome knowledge-to-practice deficits remain undefined. The Geriatric Emergency care Applied Research (GEAR) Network was organized to identify and prioritize delirium clinical questions. METHODS: GEAR identified and engaged 49 transdisciplinary stakeholders including emergency physicians, geriatricians, nurses, social workers, pharmacists, and patient advocates. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews, clinical questions were derived, medical librarian electronic searches were conducted, and applicable research evidence was synthesized for ED delirium detection, prevention, and management. The scoping review served as the foundation for a consensus conference to identify the highest priority research foci. RESULTS: In the scoping review, 27 delirium detection "instruments" were described in 48 ED studies and used variable criterion standards with the result of delirium prevalence ranging from 6% to 38%. Clinician gestalt was the most common "instrument" evaluated with sensitivity ranging from 0% to 81% and specificity from 65% to 100%. For delirium management, 15 relevant studies were identified, including one randomized controlled trial. Some intervention studies targeted clinicians via education and others used clinical pathways. Three medications were evaluated to reduce or prevent ED delirium. No intervention consistently prevented or treated delirium. After reviewing the scoping review results, the GEAR stakeholders identified ED delirium prevention interventions not reliant on additional nurse or physician effort as the highest priority research. CONCLUSIONS: Transdisciplinary stakeholders prioritize ED delirium prevention studies that are not reliant on health care worker tasks instead of alternative research directions such as defining etiologic delirium phenotypes to target prevention or intervention strategies.

  DOI

• Association between social isolation and outpatient follow-up in older adults following emergency department discharge

  Archives of Gerontology and Geriatrics · 2020 · 34 citations

  Senior authorCorresponding
  • Medicine
  • Gerontology
  • Emergency medicine
  PublisherOA PDFDOI

• Predictors of Older Adult Adherence With Emergency Department Discharge Instructions

  Academic Emergency Medicine · 2020 · 30 citations

  Senior authorCorresponding
  • Medicine
  • Emergency medicine
  • Internal medicine

  OBJECTIVE: Older adults discharged from the emergency department (ED) are at high risk for adverse outcomes. Adherence to ED discharge instructions is necessary to reduce those risks. The objective of this study is to determine the individual-level factors associated with adherence with ED discharge instructions among older adult ED outpatients. METHODS: We performed a secondary analysis of data from the control group of a randomized controlled trial testing a care transitions intervention among older adults (age ≥ 60 years) discharged home from the ED in two states. Taking data from patient surveys and chart reviews, we used multivariable logistic regression to identify patient characteristics associated with adherence to printed discharge instructions. Outcomes were patient-reported medication adherence, provider follow-up visit adherence, and knowledge of "red flags" (signs of worsening health requiring further medical attention). RESULTS: A total 824 patients were potentially eligible, and 699 had data in at least one pillar. A total of 35% adhered to medication instructions, 76% adhered to follow-up instructions, and 35% recalled at least one red flag. In the multivariate analysis, no factors were significantly associated with failure to adhere to medications. Participants with poor health status (adjusted odds ratio [AOR] = 0.55, 95% confidence interval [CI] = 0.31 to 0.98) were less likely to adhere to follow-up instructions. Participants who were older (AORs trended downward as age category increased) or depressed (AOR = 0.39, 95% CI = 0.17 to 0.85) or had one or more functional limitations (AOR = 0.62, 95% CI = 0.41 to 0.94) were less likely to recall red flags. CONCLUSION: Older adults discharged home from the ED have mixed rates of adherence to discharge instructions. Although it is thought that some subgroups may be higher risk than others, given the opportunity to improve ED-to-home transitions, EDs and health systems should consider providing additional care transition support to all older adults discharged home from the ED.

  PublisherOA PDFDOI

Recent grants

• NIH Grant R01HS018047

  NIH · $1.8M · 2015

• Paramedic-coached ED Care Transitions to Help Older Adults Maintain their Health

  NIH · $2.9M · 2015–2021

• Institutional Career Development Core

  NIH · $8.7M · 2017–2027

• NIH Grant K23AG028942

  NIH · $756k · 2010

• Mentoring and Research in Patient-Oriented Geriatric Emergency Care

  NIH · $955k · 2017–2022

Frequent coauthors

• Jeremy T. Cushman

  University of Rochester Medical Center

  353 shared

• E. Brooke Lerner

  University at Buffalo, State University of New York

  345 shared

• Gregory J. Jurkovich

  University of California, Davis

  206 shared

• Robert A. Swor

  205 shared

• Karen J. Brasel

  Oregon Health & Science University

  205 shared

• Alan Blatt

  Calspan-University of Buffalo Research Center

  203 shared

• Clare E. Guse

  Medical College of Wisconsin

  170 shared

• Amy L. Drendel

  69 shared

Education

• M.D., Emergency Medicine

  University of Wisconsin–Madison

• Other, Public Health

  University of Wisconsin–Madison

Awards & honors

• President, Society for Academic Emergency Medicine Foundatio…
• Organizational Achievement Award, Society for Academic Emerg…
• Pioneer Award, SAEM Academy of Geriatric Emergency Medicine,…
• Service Award, Scientific Review Section, American College o…
• Academic Career Achievement Award, SAEM Academy of Geriatric…

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