June 13, 2016
Models of Geriatric Care:
Rotation director: Cathleen Colón-Emeric, MD, 970-0235, VA x 6777
Overview:
This rotation provides practice experience with several models of care for frail or cognitively impaired older adults including homecare, Video-Telehealth Geriatric Consultations, Dementia Support Services (outpatient and home-based), Transitional Care Programs, Continuing Care Retirement Communities, PACE, community programs, Accountable Care Organizations, and Exercise and Mobility Programs for older adults.
General Learning Goals:
1) Collaborating with and leading multi-disciplinary teams engaged in providing care to frail older adults in a variety of settings and care models
2) Understanding the role of home care in frail and cognitively impaired older adults
3) Performing comprehensive evaluation and management of cognitive impairment, including diagnosis, pharmacologic treatment, behavioral management, caregiver training, and home safety assessments
4) Managing transitions of care in at risk older adults to reduce adverse events and unnecessary health care use
5) Understanding the role of physical activity in the maintenance of function in older adults, and providing an exercise prescription
Schedule:
1st month
MON / TUES / WED / THURS / FRI8 AM
COACH home visits (2-3 weeks)
OR
STRIDE (1-2 weeks)
/ 8-9AMCore curriculum Evidenced Based Medicine, or Long Term Care Course / 8-9AM Geriatrics Grand Rounds Duke North Room 2001 /
8 AM
Long Term Care Rounds at TFAD or CV
/ 8 AMMedicine Grand Rounds
Duke North Room 2002
9:30AM
COACH team meeting (2-3 weeks) / 9:30 CCRC
Clinic
Croasdaile** / 9 AM
Geriatrics Fellows Conf.
GRECC conf room VA (3012)
1 PM
Musculoskeletal Clinic (2 weeks) OR
TLC Partners Home visits (2 weeks)
/ 1-3 PM
VA Primary Care Clinic
OR1:30 Duke Connected Care Geriatric Rounds
/ 1 PMTelehealth Consults
OR
Geriatrics PT/OT
CLC gym(2-3 weeks) / 1 PM
Long Term Care
OR
Senior PharmAssist (2 weeks, see pre-arranged dates in table) / 1 PM
VA Primary Care Geriatrics Clinic
8B
**Notify Dr. White and the clinic at least 2 weeks before any planned absences
2nd month
MON / TUES / WED / THURS / FRI8 AM
CBOC PACT Geriatrics (2 weeks)
ORHBPC home visits (2 weeks) / 8-9AM
Core curriculum Evidenced Based Medicine, or Long Term Care Course / 8-9AM Geriatrics Grand Rounds Duke North Room 2001 /
8 AM
Long Term Care Rounds at TFAD or CV
/ 8 AMMedicine Grand Rounds
Duke North Room 2002
9AM
Gerofit Rounds (2 weeks, 9-10am)
OR
Renal Silver (2 weeks) / 9 AM
PACE (4 weeks) / / 9 AM
Geriatrics Fellows Conf.
GRECC conf room VA (3012)
1 PM
CBOC PACT Geriatrics (3 weeks)
ORHBPC home visits (3 weeks) / 1-3 PM
Telehealth Consults
OR
VA Primary Care Clinic
/ 1 PMPACE (4 weeks) / 1 PM
Long Term Care OR
Senior PharmAssist (2 weeks, Aktolga only) / 1 PM
VA Primary Care Geriatrics Clinic
8B
Fellow Responsibilities:
1. Meet with rotation director week 1, final week of rotation, and as needed to set goals, review progress, and give/receive feedback.
2. Arrange clinical experiences with the contact provider. Arrive at clinical experiences on time.
3. Participate in/lead team meetings with the interdisciplinary team.
4. Document all clinical encounters as guided by faculty.
5. Seek feedback from colleagues regularly during the rotation.
Goals and objectives by experience: see table
Evaluation
Formative:
- Fellow will seek feedback from faculty and non-MD providers.
- Fellow will meet with Rotation Director at mid-point of the rotation to review objectives and progress toward achieving them.
Summative:
- Global evaluations collected from members of the interdisciplinary team and a composite evaluation is written by the Rotation Director.
- Fellow meets with Rotation Director to review performance and achievement of learning objectives.
- Fellow meets with Program Director to review evaluation.
Required Readings: see table
June 13, 2016
Experience / Goals and Objectives / Logistics / ReadingsCOACH / · Complete home assessments in the management of patients with cognitive impairment
· Practice caregiver education and support
· Understand the risks and benefits of pharmacologic and behavioral interventions for dementia with behavioral disturbance. / Judith Davagnino, SW, VA x 6258. Review CPRS for patient information before home visit / http://jama.ama-assn.org/content/295/18/2148.short
Croasdaile Clinic / · Describe the financial model and care provided in a continuing care retirement community / Contact the clinic at least 2 weeks ahead of time if you are unable to attend. Address is 2600 Croasdaile Farm Parkway, follow signs to the clinic. Call 919 384-2571 for entry. Contact is Dr. White
Duke Connected Care / · Describe how accountable care organizations are funded, and how services provided differ from fee-for-service Medicare
· Participate in a population management program for high risk older adults / Contact Dr. White
Duke Connected Care office, 718 Rutherford Street, Durham. Review cases ahead of time in EPIC; list will be sent out to you via email the previous week / http://jama.jamanetwork.com/article.aspx?articleid=2290608&linkId=13941656
Geriatrics PACT / · Appreciate how geriatrics primary care differs from standard primary care practices including staff:patient ratios and coordination with care managers and IDT / Contact Dr. Soheili or pager (919) 970-6978.
Directions to the Raleigh CBOC, http://www.durham.va.gov/visitors/raleigh.asp
Geriatrics PT/OT / · Describe the roles of Physical, Occupational, and Speech Therapy in the care of post-acute and long-term care patients.
· Determine the appropriateness of assistive devices for older adults with mobility impairments
· Describe commonly used adaptive equipment for older adults with functional impairments / Contact Phyllis Vandenberg ahead of time to arrange dates / http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3955056/
Geriatric Video Telehealth / · Participate in evaluation and management of older patients with geriatric syndromes using telehealth
· Describe how non-face to face models of care are implemented and evaluated within health systems. / Contact Megan Pearson () VA x 5323 for schedule of consults / http://www.tandfonline.com/doi/abs/10.1080/02701960.2013.870902#.V17ObnLmrcs
Gerofit / · Understand the relationship between physical activity and the development of functional impairment in older adults
· Provide exercise prescriptions for older adults
· Understand the role of the exercise physiologist in geriatrics research, education and patient care / Email or call Adrienne Wagenblast
to arrange an experience based on their schedule for new intakes/programs for the week / http://www.sciencedirect.com/science/article/pii/S0003999311008173
http://jama.jamanetwork.com/article.aspx?articleid=183892
Home Based Primary Care / · Collect functional and psychosocial information during home visits
· Describe patient selection, team roles, and expected outcomes for a home based primary care program / Contact Linda (HBPC NP) 919 323-6866 or Carol (HBPC PA) 919 810-3612 / http://jama.ama-assn.org/content/284/22/2877.full.pdf+html
Musculoskeletal clinic / · Diagnose and treat common musculoskeletal problems including rotator cuff disorders, back pain, knee pain, and hip pain.
· Develop proficiency in common joint and bursal aspirations/injections
· Use rehabilitation as a treatment modality for musculoskeletal disorders / Email or page Dr. Kim Huffman () to introduce yourself and let her know what weeks you will be coming / http://jama.jamanetwork.com/article.aspx?articleid=1899177
PACE / · List the enrollment criteria, funding, and appropriate patient selection for PACE
· Identify how acute, post-acute, and chronic care are handled in the PACE model / Karen Oldham
Directions: https://www.google.com/maps/dir/''/durham+PACE+north+carolina/@35.9164586,-78.8434647,11z/data=!4m5!4m4!1m0!1m2!1m1!1s0x89ace555fb35e77b:0xdf5cf82d9e768d1b / http://www.sciencedirect.com/science/article/pii/S152586100800426X
Renal Silver / · Understand the role of geriatric assessment in serious chronic disease management and advanced care planning / Contact Rasheeda Hall / (add JAGS paper when published)
Senior PharmASSIST / · List principles of appropriate prescribing in older adults
· List factors that influence medication adherence in older adults
· Work with a geriatric pharmacist in a multidisciplinary team / Specific dates have been pre-arranged: 7/7, 7/21, 8/11, 8/18, 9/22, 9/29, 10/6, 10/13, 12/15, 12/29, 5/11/17, 5/25/17
Contact Marilyn Disco if you cannot go to the dates in your block month
Directions: https://www.google.com/maps/place/Senior+Pharmassist,+406+Rigsbee+Ave+%23+201,+Durham,+NC+27701/@35.9993638,-78.8992266,15z/data=!4m2!3m1!1s0x89ace47172913119:0x6662bbe60a04f883 / http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3571677/
http://pmt.sagepub.com/content/17/1/6.short
STRIDE / · Appreciate the risk of functional decline and other hazards of hospitalization associated with immobility.
· Understand the impact of an early hospital mobilization program and post-hospital discharge exercise counseling. / Contact John Bartle () VA x 6753 / http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2004.52354.x/pdf
TLC Partners / · Recognize the potential problems arising during transitions of care, and to experience a model shown to reduce recurrent hospitalizations
· Evaluate an older adult in their home environment / Contact Colleen Wojciechowski, NP by email: . Please travel with the Nurse Practitioner. Review CPRS information ahead of time and be prepared to discuss the patient’s condition and potential problems in transitions with the NP. / http://www.allhealth.org/briefingmaterials/TransitionalCareofOlderAdultsHospitalizedwithHeartFailure-1262.pdf