A multi-step education model for advancing competencies in geriatrics and interprofessional collaboration for health students.

At a time when the older adult population is increasing exponentially and health care agencies are fraught with crisis-level short-handedness and burnout, addressing the Quadruple Aim of enhancing patient experience, improving population health, reducing costs, and improving the work life of health care providers is more crucial than ever. A multi-step education model was designed to advance competencies in geriatrics and Interprofessional Collaborative Practice (IPCP) for health profession students focused on each element of the Quadruple Aim. The goals of this education were to equip students with knowledge and experience to provide team-based care for older adults and achieve satisfaction with the education program.

Creation and Implementation of a Large-Scale Geriatric Interprofessional Education Experience.

The care of the older adult requires an interprofessional approach to solve complex medical and social problems, but this approach is difficult to teach in our educational silos. We developed an interprofessional educational session in response to national requests for innovative practice models that use collaborative interprofessional teams. We chose geriatric fall prevention as our area of focus as our development of the educational session coincided with the development of an interprofessional Fall Risk Reduction Clinic.

An Innovation Center Model to Transform Health Systems to Improve Care of Older Adults.

The US population is aging faster than at any other time in our history. This growth, coupled with a slow adaptive health policy framework, is creating an urgent need to reengineer and improve the quality, safety, and cost-effectiveness of health systems to meet the needs of older adults and embrace the success we have achieved with longevity. Without rapid adoption of evidence-based models that are known to improve safety and health outcomes, we significantly jeopardize the lives of thousands of older adults receiving care under our current health systems' processes and models.

Interprofessional education model for geriatric falls risk assessment and prevention.

Background: One in three people over the age of 65 fall every year, with 1/3 sustaining at least moderate injury. Falls risk reduction requires an interprofessional health team approach. The literature is lacking in effective models to teach students how to work collaboratively in interprofessional teams for geriatric falls prevention.

Geocoding to Manage Missing Data in a Secondary Analysis of Community-Dwelling, Low-Income Older Adults.

Managing missing data in a secondary analysis is daunting, particularly if the data of interest were not included in the parent study design. The current study describes the use of geocoding to replace missing data from a parent study for a secondary analysis of socioeconomic and neighborhood characteristics in community-dwelling older adults who are dually eligible for Medicare and Medicaid. Geocoding was used to link participants' addresses to data from the American Community Survey to replace missing income and neighborhood data.

Factors that influence physical function and emotional well-being among Medicare-Medicaid enrollees.

Dually enrolled Medicare-Medicaid older adults are a vulnerable population. We tested House's Conceptual Framework for Understanding Social Inequalities in Health and Aging in Medicare-Medicaid enrollees by examining the extent to which disparities indicators, which included race, age, gender, neighborhood poverty, education, income, exercise (e.g.

The Relationship Between Organizational Characteristics and Advance Care Planning Practices.

Organizational characteristics may impede the uniform adoption of advance care planning (ACP) best practices. We conducted telephone interviews with site directors of a Midwestern state's Medicaid waiver program administered by the Area Agencies on Aging and surveyed the 433 care managers (registered nurses and social workers) employed within these 9 agencies. Care managers at 2 agencies reported more frequent ACP discussions and higher levels of confidence.

Results of the promoting effective advance care planning for elders (PEACE) randomized pilot study.

The specific aim of the PEACE pilot study was to determine the feasibility of a fully powered study to test the effectiveness of an in-home geriatrics/palliative care interdisciplinary care management intervention for improving measures of utilization, quality of care, and quality of life in enrollees of Ohio's community-based long-term care Medicaid waiver program, PASSPORT. This was a randomized pilot study (n=40 intervention [IG], n=40 usual care) involving new enrollees into PASSPORT who were >60 years old. This was an in-home interdisciplinary chronic illness care management intervention by PASSPORT care managers collaborating with a hospital-based geriatrics/palliative care specialist team and the consumer's primary care physician.

Patients' potential role in the transmission of health care-associated infections: prevalence of contamination with bacterial pathogens and patient attitudes toward hand hygiene.

Background: Transmission of health care-associated infections (HAIs) has been primarily attributed to health care workers, and hand hygiene is considered the most important means to reduce transmission. Whereas hand hygiene research has focused on reducing health care worker hand contamination and improving hand hygiene compliance, contamination of patients' hands and their role in the transmission of HAIs remains unknown.

Methods: Patients' hands were sampled by a "glove juice" recovery method and enumerated for the presence of common health care-associated pathogens.

Factors associated with advance care planning discussions by area agency on aging care managers.

Background: Initiating advance care planning (ACP) discussions in the home may prevent avoidable hospitalizations by elucidating goals of care. Area agencies on aging care managers (AAACMs) work in the home with high-risk consumers.

Purpose: To determine which AAACM characteristics contribute to an increased frequency of ACP discussions.

Disentangling consumer and provider predictors of advance care planning.

Factorial surveys were used to examine community-based long-term care providers' judgments about consumers' need for advance care planning (ACP) and comfort levels in discussing ACP. Providers (448 registered nurses and social workers) judged vignettes based on hypothetical consumers. Hierarchical linear models indicated providers judged consumers who were older, had end-stage diagnoses, multiple emergency department visits, and uninvolved caregivers as most in need of ACP.

Managing in the trenches of consumer care: the challenges of understanding and initiating the advance care planning process.

To better understand how community-based long-term care providers define advance care planning and their role in the process, we conducted 8 focus groups with 62 care managers (social workers and registered nurses) providing care for Ohio's Medicaid waiver program. Care managers shared that most consumers had little understanding of advance care planning. The care managers defined it broadly, including legal documentation, social aspects, medical considerations, ongoing communication, and consumer education.

Physician knowledge, attitude, and experience with advance care planning, palliative care, and hospice: results of a primary care survey.

Purpose: To evaluate primary care physicians' understanding of and experience with advance care planning (ACP), palliative care, and hospice and how this might affect their utilization of these services.

Methods: Investigator-generated survey.

Results: Older age, more years in practice, and more personal and professional experience with ACP were correlated with an increase in the percentage of patients with progressive, chronic life-limiting diseases with whom physicians discussed advance directives.

Improving transitions: efficacy of a transfer form to communicate patients' wishes.

The objective of this study was to test the efficacy of a standardized form used during transfers between long-term care facilities (LTCFs) and the acute care setting. The intervention consisted of development and implementation of the transfer form and education about its use. Charts from 26 LTCFs and 1 acute care hospital were reviewed at 1 and 6 months prior to initiation of the transfer form (2007) and at 1 and 6 months after initiation of the transfer form (2008); 210 patient charts were reviewed in 2007 and 172 in 2008.

The Promoting Effective Advance Care for Elders (PEACE) randomized pilot study: theoretical framework and study design.

Practice guidelines are available for hospice and palliative medicine specialists and geriatricians. However, these guidelines do not adequately address the needs of patients who straddle the 2 specialties: homebound chronically ill patients. The purpose of this article is to describe the theoretical basis for the Promoting Effective Advance Care for Elders (PEACE) randomized pilot study.

Professional judgments about advance care planning with community-dwelling consumers.

Context: There is limited research on how community-based long-term care (CBLTC) providers' personal characteristics and attitudes affect their decisions to initiate advance care planning (ACP) conversations with consumers.

Objectives: To examine judgments by CBLTC providers as to whether a consumer was in need of ACP and to compare the relative influence of situational features of the consumer with the influence of personal characteristics of the CBLTC provider.

Methods: Factorial surveys with vignettes with randomly assigned situational features of a hypothetical consumer were obtained from 182 CBLTC providers at three Area Agencies on Aging located in the Midwestern U.

The after discharge care management of low income frail elderly (AD-LIFE) randomized trial: theoretical framework and study design.

Interdisciplinary care management is advocated for optimal care of patients with many types of chronic illnesses; however, few models exist that have been tested using randomized trials. The purpose of this report is to describe the theoretical basis for the After Discharge Management of Low Income Frail Elderly (AD-LIFE) trial, which is an ongoing 2-group randomized trial (total n = 530) to test a chronic illness management and transitional care intervention. The intervention is based on Wagner's chronic illness care model and involves comprehensive posthospitalization nurse-led interdisciplinary care management for low income frail elders with chronic illnesses, employs evidence-based protocols that were developed using the Assessing Care of Vulnerable Elders (ACOVE) guidelines, emphasizes patient activation, and integrates with community-based long-term care and other community agencies.

Prevention, detection and intervention with delirium in an acute care hospital: a feasibility study.

Background.  The prevalence of delirium in acute care hospitals ranges from 5-86%. Delirious patients are at greater risk of negative health outcomes and their care is often more costly.

A randomized trial testing the superiority of a postdischarge care management model for stroke survivors.

Objective: We sought to evaluate whether comprehensive postdischarge care management for stroke survivors is superior to organized acute stroke department care with enhanced discharge planning in improving a profile of health and well-being.

Methods: This was a randomized trial of a comprehensive postdischarge care management intervention for patients with ischemic stroke and National Institutes of Health Stroke Scale scores greater than or equal to 1 discharged from an acute stroke department. An advanced practice nurse performed an in-home assessment for the intervention group from which an interdisciplinary team developed patient-specific care plans.

Accuracy of a bedside dysphagia screening: a comparison of registered nurses and speech therapists.

Evidence-based guidelines suggest that stroke patients should be screened for dysphagia before oral intake. The purpose of this study was to validate a dysphagia screening tool comparing registered nurses (RNs) with speech therapists (STs). All stroke unit patients who received predetermined scores on specific items of the National Institutes of Health Stroke Scale were eligible for screening.

Effectiveness of Chloraprep in reduction of blood culture contamination rates in emergency department.

Contaminated blood cultures result in increased healthcare utilization. Poor skin preparation is usually the cause of contamination. Our study results showed a significant decrease in contamination rates using 2% chlorhexidine and 70% isopropanol (Chloraprep) versus tincture of iodine.

A validation of self-reported substance use with biochemical testing among patients presenting to the emergency department seeking treatment for backache, headache, and toothache.

Purpose: This study tests the validity of self-reported illicit substance use against biochemical testing among Emergency Department (ED) patients seeking treatment with narcotics for backache, headache, and toothache and to characterize patients who provide false reports.

Methods: Retrospective chart review comparing the self-reported drug use history obtained during an ED visit during a six-year period (1995-2001) with the results of a biochemical drug screen obtained the same day.

Results: 248 patients met screening criteria, 79 (32%) of whom tested positive for unclaimed "drugs of abuse.

Vitamin D supplementation to prevent falls in the elderly: evidence and practical considerations.

Pharmacists in both ambulatory and institutional settings are often in a position to help optimize the drug regimens of patients who are experiencing falls. Supplementation with vitamin D is an important emerging therapy for the prevention of falls. Numerous investigators have recently studied or reviewed the association between vitamin D supplementation and decreased risk of falls in elderly patients, yet little of this information is available in the pharmacy literature.

Effectiveness of a postdischarge care management model for stroke and transient ischemic attack: a randomized trial.

Background: This randomized controlled trial tested the effectiveness of comprehensive, interdisciplinary postdischarge care management in improving a profile of indicators of health recovery and secondary prevention (profile of health and prevention) in stroke and transient ischemic attack (TIA) patients.

Methods: Ninety-six stroke/TIA patients were randomized to usual care or intervention at discharge from our acute stroke unit. The intervention group received an in-home biopsychosocial assessment by an advanced practice nurse at 1 month.

The AD-LIFE trial: working to integrate medical and psychosocial care management models.

Interdisciplinary care management that fully integrates medical and social care is advocated for optimal care of patients with many types of chronic illnesses, yet the effectiveness of this care model has been insufficiently tested using randomized controlled trials. This article presents the results of a pilot care management program and a description of a larger randomized controlled trial modeled after the pilot program (the After Discharge Care Management of Low-Income Frail Elderly [AD-LIFE] trial). It compares an integrated medical and social care management model (intervention group) with a purely social model (control group) involving low-income elderly patients with chronic conditions and functional impairment at high risk for rehospitalization or nursing home placement.