Here - American Geriatrics Society

P OSTER
A BSTRACTS
made more eye contact during anxiety-provoking visits, patients
made more eye contact during routine visits. Given the rising prevalence
of prostate cancer (PCa) in the aging population, the likelihood
of PCa communication being anxiety-provoking, and the role of anxiety
in decision-making about PCa, we compared eye contact during
PCa communication with other clinical interactions.
Methods: We analyzed NIA videotapes of older men and male
physician interactions (n=26) during three different types of clinical
visits involving: 1) PCa (n=9), 2) other anxiety-provoking situations
(depression/suicidal ideation, behavioral issues, and acute medical issues;
n=9), and routine situations (n=8). Using NVivo 9 Qualitative
Software, history-taking segments were time-stamped and transcribed
for each tape, enabling simultaneous independent assessment
of eye contact—in terms of length, frequency and quality—and
speech of both physicians and patients.
Results: Compared to other situations, the length and frequency
of physician eye contact was lowest during PCa interactions. The
quality of eye-contact during PCa communication was characterized
by the lowest number of sustained eye contact episodes per visit (1.5),
followed by slightly higher number in routine visits (2), and the highest
during anxiety-provoking visits (3). In contrast, patients made the
most eye contact in PCa and routine visits, and least in other anxietyprovoking
visits. The amount of verbal communication between
physicians and patients was similar. The frequency of eye contact of
physicians and patients was about twice that of verbal speech.
Conclusions: Physicians and patients display different eye contact
patterns during discussions of PCa when compared with other
anxiety-provoking and routine care discussions. While the frequency
of verbal utterances was similar, physicians display least eye contact
while patients display most eye contact during PCa discussions. Understanding
nonverbal communication patterns and designing interventions
to improve eye contact can help enhance patient-centered
communication for this preference-sensitive disease.
A104
QI Reducing 25 OH Vitamin D Ordering.
R. Aminbakhsh, 1 Z. Aung, 1 G. Guo, 1 D. Chau, 1 S. Leong. 2 1. Internal
Medicine, University of Nevada School of Medicine, Reno, NV; 2. Lab
and Pathology, Veteran Affairs, Reno, Reno, NV.
There has been an increase in the 25 OH Vitamin D lab orders
to our VA healthcare system without any clear evidence based data to
document appropriateness, need for general testing, and guidance.
Recently, The IOM [Institute of Medicine]concluded that there’s evidence
of vitamin D benefits for bone, but there is not enough on nonbone
outcomes. Target blood level of 25OH vitamin D- 20 ng/mL
cover the needs of at least 97.5% of the population. Labs for vit. D
have variable ranges & these ranges can mislabel patients. At our Veteran
Affairs approx. 1500 tests are sent per month at a cost of $18 per
test. PARTICIPANTS of the QI project consisted of all ambulatory
and hospital care providers who ordered 25 OH Vitamin D from August
to November of 2011. # 25OHD Labs ordered by provider was
reviewed (2011):August 982;September 1531;October 1078. INTER-
VENTION: The QI team sent an educational letter September 2011
based upon the IOM report, possible unneccessary testing to the VA
primary care providers. This letter provided providers with the education,
guidance, and recs on appropriate 25 OH Vitamin D lab testing.
Following the letter, the team reviewed the lab orders for vitamin D
and provided 1:1 education based on IOM directed towards PCPs
who ordered high #s of tests. 2/10 PCPs ordered 20% of vit.D lab,5x
more # of tests than by endocrinologist. In addition to education, a
new in house lab for vitamin D testing was implemented standardizing
D ranges of lab reported. MEASUREMENTS: We reviewed the
lab orders for vitamin D prior to the quality improvement education
process, the cost of the lab testing pre and post education. RESULTS:
Of the 3591 tests ordered of 25 OHD from August - October only 8%
had abnormal 25 OH vitamin D values, including deficient and insufficient
vitamin D status. After the preliminary intervention, the 25 vitamin
D lab test ordered was reduced from 1531 in the month of September
to 1078 in the month of October a drop of 29.59%.CONCLU-
SION: A QI project using educational email plus 1:1 education to
outlying providers, and internally standardizing 25 OH lab reports
lowered the number of vitamin D testing and abnormal reporting. We
have also proposed to provide more education for primary care
physicians through additional 1:1 and team education.
A105
Does Low Social Support Predict Hospitalization and Outcomes
among Aging Veterans with and without HIV?
R. Greysen, 1 L. I. Horwitz, 2 K. E. Covinksy, 1 R. Desai, 2 M. E. Ohl, 3
M. Duggal, 2 A. C. Justice. 2 1. Dept of Medicine, University of
California, San Francisco, CA; 2. Dept of Medicine,Yale University,
New Haven, CT; 3. Dept of Medicine, University of Iowa, Iowa City, IA.
BACKGROUND: Social isolation is common among aging Veterans,
especially those infected with HIV, and may affect healthcare
utilization and outcomes of care. Our objectives were to compare levels
of social support in aging Veterans with and without HIV and determine
associations between social support and hospital admission,
length of stay, and disposition.
METHODS: Using the Veterans Aging Cohort Study we created a
10-point scale for social support using survey responses about: marital
status, housing status, food security, number of friends/family and frequency
of visits,and involvement in volunteer work,religious or self-help
groups, or other community activities. We stratified data by HIV status
and used multivariable regression to assess effects of social support on
admission, length of stay, and skilled nursing facility (SNF) placement.
RESULTS: Data were available for 1,836 Veterans: age 55-91
(mean=61), 98% male, 68% non-white, 76% annual income