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P APER A BSTRACTS Conclusion: This study provides evidence that use of medications with strong or moderate AC effects in older women is associated with increased risk of falls, clinical vertebral fracture, and total fractures, but is not associated with hip fracture or lower arm/wrist fracture. P32 Falls among Adult Patients Hospitalized in the United States: Prevalence and Trends. E. L. Bouldin, 1,2 E. M.Andresen, 2,3 N. E. Dunton, 4 M. Simon, 5 T. M.Waters, 8 M. Liu, 2 M. J. Daniels, 2 L. C. Mion, 6 R. I. Shorr. 7,2 1.VA Puget Sound HSR&D, Seattle,WA; 2. University of Florida, Gainesville, FL; 3. Instistute on Disability and Development, Oregon Health & Science University, Portland, OR; 4. Health Policy and Management, University of Kansas Medical Center, Kansas City, KS; 5. Health Sciences, University of Southampton, Southampton, United Kingdom; 6. School of Nursing,Vanderbilt University, Nashville,TN; 7. Geriatric Research Education & Clinical Center, Malcolm Randall VA Medical Center, Gainesville, FL; 8. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis,TN. Supported By: NIH/NIA R01-AG025285, NIH/NIA R01-AG033005 Background:The purpose of this study was to provide normative data on fall prevalence in US hospitals and to determine 27-month secular trend in falls prior to the implementation of the Centers for Medicare and Medicaid Service (CMS) rule which does not reimburse hospitals for care related to injury resulting from hospital falls. Methods: We used data from the National Database of Nursing Quality Indicators (NDNQI) collected between July 1, 2006 and September 30, 2008 to estimate prevalence and secular trends of falls occurring in adult medical, medical-surgical and surgical nursing units. More than 88 million patient days (pd) of observation were contributed from 6,100 medical, surgical, and medical-surgical nursing units in 1,263 hospitals across the United States. Results: A total of 315,817 falls occurred (rate=3.56 falls/1,000 pd) during the study period, of which 82,332 (26.1%) resulted in an injury (rate=0.93/1,000 pd). Both total fall and injurious fall rates were highest in medical units (fall rate=4.03/1,000 pd; injurious fall rate=1.08/1,000 pd) and lowest in surgery units (fall rate=2.76/1,000 pd; injurious fall rate=0.67/1,000 pd). Falls (0.4% decrease/quarter, p
P APER A BSTRACTS age increased, the overall rate of catheterization for all older inpatients declined from 19.9% to 11.9%, a 40% reduction. The greatest improvement was seen on the ACE Unit, where the rate of catheterization declined from 20.4% to 9.7%, a 53% reduction. The catheter utilization ratio decreased from 68% to 20%, while the average catheter days per patient declined from 11.7 to 2.8 days per patient across all inpatient units. Conclusions: This study demonstrates the dramatic and sustained improvements in catheter utilization that can be achieved with the support of a multi-modal educational intervention in improving patient safety and quality care efforts around the appropriate use of urinary catheters in a variety of inpatient settings. P35 A Geriatrics rotation as a Medicine elective: A smart option for medical students? A. Nguyen , 1 E. Duthie, 1 E. Duthie, 2 K. Denson, 2 J. Franco. 2 1. Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI; 2. Internal Medicine, Medical College of Wisconsin, Milwaukee, WI. Background: Medical schools must look at innovative ways to ensure that graduates achieve basic competencies in geriatrics and encourage new physicians to consider the subspecialty. Our objectives are to: 1) assess the impact of a month-long geriatrics rotation, as part of the internal medicine clerkship, on M3 students’ knowledge, skills, and attitudes toward geriatric practice and career choice; and 2) assess knowledge outcomes by comparing mean NBME internal medicine shelf exam scores between students who completed the geriatrics rotation and students who completed the internal medicine ward rotations. Methods: This study was conducted at a medical school where a month-long geriatrics evaluation and management (GEM) rotation fulfills a graduation requirement in internal medicine. One-hour focus groups were conducted with two cohorts: 1) students who rotated through GEM and 2) students who did not. Thematic analyses using the principles of grounded theory were performed to compare group responses between the two cohorts. One focus group of 4-6 participants was conducted for each cohort. Independent t-test was performed to compare mean NBME internal medicine shelf exam scores between all GEM (n=124) and non-GEM (n=1318) students who matriculated between 2005 and 2011. ANOVA was used to compare the means after controlling for Step 1 exam scores. Results: Focus groups revealed differences in reported comfort and attitudes toward geriatric care with the GEM cohort reporting higher levels of confidence with geriatric assessment skills. Mean NBME internal medicine shelf exam scores between GEM students [mean (SD)=73.66 (±7.2)] and non-GEM students [mean (SD)=73.60 (±7.4)] were not statistically significant (p=0.938). Controlling for Step 1 scores did not produce statistically significant differences (p=0.371). Conclusion: Completing an internal medicine ward rotation requirement using a geriatrics rotation is an innovation that medical schools should consider. Comparisons of NBME scores show that GEM students perform just as well on the internal medicine board exam as their non-GEM colleagues but were more comfortable with elder care. Evaluating geriatrics curricula will add to understanding of student perspectives about geriatrics as a career field and allow curriculum developers to identify areas of strength and areas for improvement. P36 Case Presentation as a Direct Observation Method to Evaluate Internal Medicine Residents’ Systems-Based Practice Competency. K. Ouchida, S. Ramsaroop, S. Mehta, L. Logio, R. Adelman, E. Siegler. Medicine, Weill Cornell Medical Center New York Presbyterian Hospital, New York, NY. PURPOSE: Of the 6 core competencies the Accreditation Council of Graduate Medical Education requires, systems-based practice (SBP) often poses the greatest challenge for curriculum development and evaluation. A redesigned geriatrics rotation for internal medicine (IM) residents incorporates a SBP module with direct exposure to health care sites and services utilized by older adults. This study describes the use of a case presentation to evaluate IM residents’ knowledge of the health care system and ability to navigate it. METHODS: Starting June 2011, all PGY-2 IM residents (N=48) complete a 1-week SBP module as part of the required 4-week geriatrics rotation. The module combines structured exposures to community-based programs, supervised patient care on house calls and in a transitional care clinic, and self-directed learning. Residents present an older continuity patient to the geriatrics interdisciplinary team, which then models a collaborative problem-solving approach. One faculty member takes notes and emails residents a summary of the identified problems and the team’s “action plan.” The problems and recommendations were analyzed to generate a list of themes for coding. Discrepancies in coding were resolved by discussion until consensus was reached. RESULTS: To date 21 (44%) IM residents have presented cases. Presentations generated 19 types of biopsychosocial issues (mean 3.8 per patient) and 12 types of recommendations (mean 5.4). Lack of social support (15.1%), care coordination challenges (13.9%), and negative illness behaviors such as refusal of care (10.1%) represent the most frequently identified problems. The interdisciplinary team’s recommendations most often focused on care coordination strategies (15%), community resources (14.2%), medical treatment or workup (14.2%) and goals of care (13.3%). The case presentation received one of the highest ratings from residents on the module evaluation (4.75 out of 5). CONCLUSIONS: A case presentation represents an effective strategy for directly observing and evaluating IM residents’ systemsbased practice competency. Presentations reveal residents’ struggles with the health care system and comprehension of their older patients’ needs, and offer exposure to geriatric approaches through practical advice. This evaluation method is feasibly implemented and well-received by residents. P37 Replicating a Chief Resident Immersion Training in Geriatrics (CRIT). S. Levine, 1 L. Caruso, 1 B. Brett, 2 H. Auerbach, 1 A. Jackson, 1 A. Burrows, 1 S. Chao. 1 1. Boston Univerisity Medical Center (BUMC), Boston, MA; 2. Brett Consulting Group, Boston, MA. Supported By: John A. Hartford Foundation, Association of Directors of Geriatric Academic Programs (ADGAP) Background: Chief residents (CRs) play crucial roles in resident and student training and in quality patient care. They typically receive minimal formal education in geriatrics, teaching skills and leadership. With support from the John A. Hartford Foundation and ADGAP, BUMC disseminated its successful 2-day offsite CRIT program, addressing these deficiencies, to demonstrate national replicability. Methods: Through a competitive RFP, 12 institutions in 3 cohorts were selected to implement CRIT across specialties for 2 years each. The modular curriculum included an unfolding case discussed in small groups, evidence-based mini-lectures on geriatrics topics, and interactive seminars on teaching and leadership skills. 1-to-1 consults helped CRs develop an action project. Social opportunities were provided to develop relationships. Faculty mentors were invited to increase institutional “buy-in.” BUMC’s support to each institution included attending BUMC’s CRIT. National evaluation of CRIT included a self-report pre-survey, a 12-item pre- and immediate post- CRIT knowledge test, and a 6-month follow-up survey, administered by each institution. Results across institutions and cohorts were merged for analysis. Results: Over 3 years in 12 institutions, 301 CRs and 86 faculty mentors participated in CRIT, representing 29 specialties. Response AGS 2012 ANNUAL MEETING S13
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P OSTER A BSTRACTS BMI=28.4, mean P
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P OSTER A BSTRACTS There is growing
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P OSTER A BSTRACTS 2.47-25.96), and
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P OSTER A BSTRACTS D114 Fall Reduct
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A UTHOR I NDEX Azhar, G . . . . . .
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A UTHOR I NDEX Ceimo, J . . . . . .
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A UTHOR I NDEX Dunn, C M . . . . .
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A UTHOR I NDEX Levine, M . . . . .
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A UTHOR I NDEX Pschirer, J P . . .
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A UTHOR I NDEX Sheppard, K D . . .
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A UTHOR I NDEX Ukritchon, S . . . .
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K EYWORD 25-hydroxyvitamin D . . .
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K EYWORD I NDEX Colorectal cancer s
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K EYWORD I NDEX Geriatric curriculu
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K EYWORD I NDEX Medication discrepa
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K EYWORD I NDEX Race . . . . . . .
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