Geriatric Medicine Training and Practice in the United States at the ...

Project Methodology
National Oversight Panel
A National Oversight Panel was established to review, advise on, and
approve the project work plan (see Acknowledgement page). The
panel met in Chicago on September 21, 2000 to review and prioritize
the planned database content items and identify primary and
secondary data sources. It met again on January 28, 2002 in Orlando,
Florida, to comment on an early draft of this report. Throughout the
course of this project, panel members have contributed in various
ways, such as helping in developing and reviewing survey questions,
pre-testing surveys, and assisting with plans to acquire existing data,
including data from their own organizations.
Project Setting and Team
The Office of Geriatric Medicine and the Institute for Health Policy and
Health Services Research (IHPHSR) at the University of Cincinnati (UC)
Medical Center are administering this database formation project for
ADGAP. Gregg Warshaw, MD, Project Director, is Director of the Office
of Geriatric Medicine at UC. The IHPHSR is a multidisciplinary research
organization composed of several research centers offering a wide
range of programs and services including expertise on database
design and management, mail and web surveys, biostatistics, and
data archiving. IHPHSR staff working on the project include a project
manager, biostatistician, data manager, survey developer, web site
developer, junior research associate, and an archivist/network
administrator. (See acknowledgements for a complete list of the
IHPHSR Project Staff.)
Acquisition and Organization of
Existing Data
During the first project year, we identified individuals and
organizations involved in geriatric medical education, including groups
that conduct surveys, maintain databases, and/or develop geriatric
medicine curricula. We have developed collaborative relationships with
these individuals and organizations (Table 2.1). Project staff conducted
on-site visits to the Association of American Medical Colleges (AAMC),
National Institute on Aging (NIA), Veterans Health Administration (VHA),
American Board of Family Practice (ABFP), American Medical
Association (AMA), and the Accreditation Council for Graduate Medical
Education (ACGME). A summary of data collected from existing
sources is presented in Table 2.2.
The IHPHSR project team is successfully collaborating with
several ongoing data collection projects. The University of Rochester,
under the direction of Annette Medina-Walpole, MD, completed a
survey of 1990-1998 graduates of residency review committees
(RRC)-approved Family Practice (FP) and Internal Medicine (IM)
geriatric medicine fellowships. The results of this study are presented
in Chapter 6. In addition, with assistance from the Rochester group,
we have transferred the surveyed fellows’ contact information to the
IHPHSR (with the fellows’ permission). We will maintain and update
this database through future surveys. The IHPHSR team has also
closely followed the work conducted as part of the Society of General
Internal Medicine’s project, Training General Internists in Geriatrics:
Table 2.1 Data Sources
• Accreditation Council for Graduate Medical Education
• American Association for Geriatric Psychiatry
• American Board of Family Practice
• American Board of Internal Medicine
• American Board of Medical Specialties
• American Board of Psychiatry and Neurology
• American Foundation for Aging Research
• American Geriatrics Society
• American Medical Association
• American Medical Directors Association
• American Osteopathic Association
• Association of American Medical Colleges
• Bureau of Health Professions
• National Institute on Aging
• The John A. Hartford Foundation of New York City
• University of Rochester, Geriatric Medicine Program
• Veterans Health Administration
Planning for Sustained Improvement. Excerpts from the background
paper prepared for that project, Improving Geriatrics Training During
Internal Medicine Residency Programs, are given in this report (see
Chapter 7).
We are compiling, on an on-going basis, data from various
other organizations involved in the training and practice of geriatric
medicine. Our activities are oriented toward identifying, acquiring, and
organizing this data. All data that are collected annually are being
organized into a relational database; a database in which several
tables are related by means of key variables. The structure is defined
to ensure sufficient storage of data and to allow easy linking between
different types of data. This structure will be used to organize
subsequent data that are available for multiple years. It will allow for
query of data by year, by a particular agency, or by a specific variable
such as number of certified geriatricians. It will also provide easy
access to data definitions for researchers who might want to know,
for example, if the data is gathered by academic year (AY), calendar
year (CY), or fiscal year (FY). Future plans include updating acquired
data annually, obtaining data that has been identified but not yet
included in our database, searching for new data sources, and
making the data web-accessible.
IHPHSR Surveys
During the 2000-2002 project period, the IHPHSR conducted
surveys of the following groups:
• Program Directors of Family Practice Residency Programs
(Winter 2001);
• Directors of Geriatric Academic Programs in U.S. Allopathic
and Osteopathic Medical Schools (Spring 2001);
• Directors of Allopathic and Osteopathic Geriatric Medicine
Fellowship Programs (Fall 2001);
• Directors of Geriatric Psychiatry Fellowship Programs (Fall 2001);
• Program Directors of General Internal Medicine Residency
Programs (Winter 2002);
The surveys could be completed either on paper or online. To
improve response rates and ensure that the surveys covered material
most relevant to the target groups, we collaborated with the
15