The Institute for Post-Acute and Senior Care Kyle Allen, D.O. Medical Director, Post Acute & Senior Services, Summa Health System Chief, Division of Geriatric Medicine Professor, Internal and Family Medicine Northeastern Ohio Universities College of Medicine and Pharmacy

A Comprehensive Approach Summa Health System Serves a five county region in Northeast Ohio Seven owned, affiliated and joint venture hospitals Regional network of ambulatory centers 240+ employed multi-specialty group A 150,000+ member health plan A System-level foundation 10,000+ employees Total Net Revenue of $1.6 Billion Total Discharges of 61,000

New ACE Model Applications The Interdisciplinary ACE Team focused on geriatrics and chronic care management Applied to Stroke Unit Achieving ACE-like Benefits  Reduced Average Length of stay  Improved ADL function  Decreased discharge to LTC  Increased Patient, Nurse, Physician Satisfaction  Changes in process of care:  Less bed rest  Early discharge planning  Fewer high risk medications  Depression recognized and treated

ACE-like Stroke Unit Results Risk-Adjusted In-Hospital Mortality Rate for Medicare Stroke Patients Pre-SUPost -SU  Increased discharge to home  Decreased discharge to acute rehab  Decreased readmission rate  Decreased mortality  Decreased Average Length of Stay Other Quality Improvements

ACE Unit Principles Lowering Cost of Care  While Summa’s ACE Unit outperforms the rest of the hospital, the pattern of care has spread to the rest of the facility and led to significant cost savings in DRGs with high Medicare populations

Where Care for Older Adults is Headed: AD-LIFE and PEACE  Post-discharge care management of low income frail elderly  Nurse care manager activation of client  Collaboration between a hospital-based interdisciplinary team, Area Agency on Aging, and PCP  Integration of acute and long-term care  AD-LIFE trial is supported by the Agency for Healthcare Research and Quality Grant # R01 HS  PEACE is funded by the National Palliative Care Research Center  Both are supported by Summa Foundation