Here - American Geriatrics Society

P OSTER
A BSTRACTS
James A. Haley VA Tampa FL
Background:
Nationally, 20% of veterans discharged from a VA inpatient
care unit are readmitted within 60 days of discharge. As a quality improvement
program, the Tampa VA initiated a Home Based Transitional
Care Program to support discharged veterans during the first
28 days following a hospital discharge.
Program Description:
The program is consult based and provides for an in home visit
by an RN and Kinesiotherapist. The RN visit which occurs within 4
days of discharge includes medication reconciliation, review and reinforcement
of discharge orders, identification of clinical status changes,
offering and coordination of enrollment for chronic care programs
such as CCHT, HBPC, MFH and/ or purchased home care services.
The RN provides follow-up care and case management for up to 28
days. The kinesiotherapist performs a home safety evaluation (environmental
and functional assessments); fall risk assessment, and recommends
or orders necessary equipment for home safety. The team
members provide follow-up care and education for up to 28 days.
Outcomes:
Veterans serve as their own baseline for rate of readmission for
a maximum of 6 months prior to the index discharge during which the
HBTC consult was placed. A readmission rate is established for each
veteran during a time frame equal to the amount of time that has
passed since the veteran was seen by the HBTC team for up to a maximum
of 6 months.
Analysis was completed on 120 patients seen Oct 2010 thru Sept
2011. Readmission rates were reduced by 28% at 14 days, 33% from
15-30 days, and 68% over 30 days. There was a 50% reduction in bed
days of care.
For those evaluated, 53% had medication errors identified, 56%
were recommended additional home services, 39% were issued nursing
supplies, 73% were issued DME, and 100% were educated regarding
medication and home safety.
From program participant surveys:
85% felt comfortable after hospital discharge.
100% felt HBTC staff was professional.
30% claimed HBTC staff taught them something new.
100% endorsed that medications were explained thoroughly.
95% stated that HBTC increased their satisfaction with the VA.
55% claimed that their HBTC visits prevented them from going
back into the hospital.
100% of veterans who were provided with supplies stated that
the usage of equipment or supplies was properly demonstrated.
D118
Multi-faceted effort to improve Hospitalized senior care at a large
Tertiary teaching medical center.
S. Soryal, 1 K. Padua. 2 1. American Geriatrics Society, Milwaukee, WI;
2. geriatrics, Aurora health care, milwukee, WI.
Supported By: non
Our model of care was created to improve senior care in a large
tertiary care hospital focusing on three different efforts.
The first effort is implementing the ACE Concept on almost all
hospital floors. The Acute Care for The Elders concept focuses on
prepared environment with standard equipment for seniors, patientcentered
interdisciplinary care, medical review by a geriatrician as
part of the interdisciplinary team, and early discharge planning. Our
ACE Concept was implemented on sixteen different medical floors
(fourteen of them were medical surgical floors, one medical intensive
care unit, and one inpatient rehab unit).
Geriatricians lead the team utilizing an innovative electronic
medical record tool called ACE tracker, which in real-time identifies
high risks patients for complications in the hospital.
The second effort was the collaboration with the hospitalist
group by attending the morning rounds once a week in a geriatric
hospitalist rounds discussing patients who are in the hospital who are
80 years and older. The geriatrician will also use ACE tracker to identify
high risks patients for complications and use the opportunity as
an educational time for group of nine hospitalist.
The third effort was to start ACE consult service and accept referrals
from admitting physicians to help manage complex patients in
the hospital. Most of the reasons for referrals were to manage delirium,
agitation, dementia, functional decline, frailty, polypharmacy,
identify goals and plans of care, and discharge planning. Physicians
who requested referrals were hospitalist, family practices physicians,
internal medicine physicians, cardiologists, physiatrists, critical care
specialists, neuro-surgeons, and orthopedic surgeons.
After one Year the ACE program showed improvement in
processes of care by decreasing Foley catheter use, reducing restraint
use for non-ICU floors and increase in PT/OT and social
service referrals.
The Geriatrics hospitalist round have helped the hospitalists as
they care for seniors and they expressed their satisfaction thru a survey
conducted.
The ACE program has seen 478 consults in its first Year and
Geriatricians were able to show cost savings for patients seen on consult
service( 252 $ per patient ) and reducing length of stay by one day.
D119
Using Cognitive Screens to Predict Pillbox Organizational Skills.
K. J. Anderson, 1,2 A. Huie-Li, 3 C. Willmore. 4 1. Clinical Pharmacy,
Cross Road Medical Center, Glennallen, AK; 2. Pharmacists Int’l
Consulting Specialists, University Place, WA; 3. Clinical Pharmacy, VA
Connecticut Healthcare System, New Haven, CT; 4. Pharmacology,
Union University, Jackson, TN.
Supported By: This study was funded by Blue and You Foundation
for a Healthier Arkansas.
Background:Proactive assessment of medication management
skills can mitigate adverse medication-related events thereby reducing
incidence of emergent care or exacerbation of chronic
disease.Brief cognitive/pillbox skill screens were correlated with pillbox
loading accuracy for predictive value using the patient’s medications.Methods:We
conducted a prospective, cross-sectional, pilot
study in a rural primary care clinic.Inclusion criteria:diagnosis of diabetes
and ability to load a pillbox with >1 medication. Cognitive/literacy/pillbox
skills screens were administered during 3 visits over a ~6
mo period.Pillbox assessment (personal medications loaded in a 28-
compartment pillbox) was initiated when the patient presented with
medications. Average completion time was ~30 min scored by Pillbox
Fill (PBF) method.Screens administered: Mini-Cog=Three Item Recall
and Clock Draw Test (short and long-term memory); Medication
Transfer Screen=MTS (decipher 4 prescriptions, sequence and locate
pills in a pillbox, count); Medi-Cog=Mini-Cog+MTS, Medication
Safety Screen=MEDScreen (Three Item Recall and MTS SF - abbreviated
2-question MTS); 4 o’clock screen=FIR+CDT+AFS (Four Item
Recall, Clock Draw Test, and Animal Fluency Screen); and MTS-
Bean Fill=MTS BF (decipher 4 prescriptions, sequence and locate
beans in a pillbox, count).Results: Forty-nine patients completed the
study: ave age 60, (range 36-84 yrs); 55% AA and 45% White; 71% F;
47% with