Improving Care for Older Adults with Serious Illness Amy S. Kelley, MD MSHS Brookdale Leadership in Aging, 2009 Fellow Mount Sinai School of Medicine June.

Slides:

Advertisements

Similar presentations

Quality of Life: 101.

Advertisements

Making It As a Clinical Researcher or Educator

Minorities and the medically underserved in clinical trials Edward L. Trimble, MD, MPH CTEP, DCTD, NCI.

Delivering care to the underserved: Increasing the Numbers of Minority Physicians Ruben Gonzalez MD CCRMC.

Arkansas Telehealth: Shaping the Future of Healthcare Curtis L. Lowery, M.D. Professor and Chair Department of Obstetrics and Gynecology University of.

Connie N. Hess, MD, Bimal R. Shah, MD, MBA, S. Andrew Peng, MS, Laine Thomas, PhD, Matthew T. Roe, MD, MHS, Eric D. Peterson, MD, MPH Relationship of Early.

Academic Training Programme in the in the East Midlands Healthcare Workforce Deanery (South) (South)

System and Service Design for Older Adults Asangaedem Akpan MPhil FRCPI FRCP(UK) Consultant in Community Geriatric Medicine & Health Foundation/Institute.

Middle Atlantic Actuarial Club September 17, 2009 Baltimore, MD Shannon Brownlee, MS Senior Research Fellow, New America Foundation Overtreated: Why Too.

Oakland University William Beaumont School of Medicine An Opportunity of a Lifetime.

How is place of death for cancer patients changing and what affects it? UKACR Conference September 28 th 2004 Elizabeth Davies Karen Linklater Ruth Jack.

Readmission and Chronic illness that could benefit from end of life discussions.

Surveillance of Heart Diseases and Stroke Using Centers for Medicare and Medicaid (CMS) Data: A Researcher’s Perspective Judith H. Lichtman, PhD MPH Associate.

Successful Approaches to Reduce Hypertension Stephen Sidney, MD, MPH Kaiser Permanente Northern California October 17, 2012.

Program Development for Safety Net Institutions Catherine Deamant, MD Director, Palliative Care Services Cook County Health and Hospitals System Coleman.

The Big Puzzle Evolving the Continuum of Care. Agenda Goal Pre Acute Care Intra Hospital Care Post Hospital Care Grading the Value of Post Acute Providers.

End-of-life care costs in Los Angeles are much higher than San Diego. In San Diego, 45% of those who died were in hospice during the last six months compared.

Nancy D. Zionts Chief Operating Officer Chief Program Officer Jewish Healthcare Foundation © 2013 JHF & PRHI.

Linda D Urden, DNSc, RN, CNS, NE-BC, FAAN Professor and Director Master’s and International Nursing Programs Hahn School of Nursing and Health Science.

The Social Work in Hospice and Palliative Care Network (SWHPN)

Assessing Chronic Illness Care in Prison (ACIC-P): A Tool for Tracking Chronic Illness Care in Prison Emily Wang, M.D., MAS Yale University School of Medicine.

Collection of Race, Ethnicity, and Language Preference Data in a Complex Healthcare Organization Brian Currie, MD, MPH Montefiore Medical Center Bronx,

DataBrief: Did you know… DataBrief Series ● February 2011 ● No. 14 Racial/Ethnic Disparities in Disability Approximately 1 out of 3 Black and Hispanic.

Variation in the Delivery of Medical Care: Is More Better? Todd Gilmer, PhD Professor of Health Policy and Economics Department of Family and Preventive.

Preventive Health Care Use in Elderly Uterine Cancer Survivors Division of Health Policy and Management School of Public Health University of Minnesota.

EPECEPEC Elements and Gaps in End-of-life Care Plenary 1 The Education in Palliative and End-of-life Care program at Northwestern University Feinberg School.

Improved Treatment of Ischemic Heart Disease and Disability and Death in the Elderly Kate Stewart Mary Beth Landrum David Cutler Academy Health June 27,

Hospice Dis-Enrollment and Quality of Care at the End-of-Life Melissa D.A. Carlson, Ph.D., M.B.A. Brookdale Department of Geriatrics & Adult Development.

PALLIATIVE CARE WORKING AS A TEAM TO IMPROVE YOUR QUALITY OF LIFE May 2013.

Deepthi Mohankumar,PhD Postdoctoral Fellow Faculty of Nursing, University of Alberta.

INTENSITY OF HEALTH SERVICES AND COSTS OF CARE FOR PREVIOUSLY UNINSURED MEDICARE BENEFICIARIES J. Michael McWilliams, M.D. Division of General Medicine.

Corita R. Grudzen, MD, MSHS Department of Emergency Medicine Brookdale Dept of Geriatrics and Palliative Medicine R. Sean Morrison, MD & Lynne D. Richardson,

Academic Advancement As A Clinician Educator Donald W. Reynolds Foundation Grantee 2010 Annual Meeting Daniel Swagerty, MD, MPH Professor, Departments.

Elizabeth A. Martinez, MD, MHS Johns Hopkins Medical Institutions September 10, 2008 Organization of Care and Outcomes in Cardiac Surgery AHRQ grant 1K08HS A1.

Evolution & Maturation of the Practice of Hospice and Palliative Medicine Charles F. von Gunten, MD, PhD May 16, 2013 Vice President, Medical Affairs Hospice.

Outcomes Tier 2 – PI-LDP Course Tier 3 – ATP or mini-ATP Tier 1 – ACT Program Three Tiers of QI TrainingAbstract DEVELOPMENT OF FACULTY MENTORS IN QUALITY.

Differences in the Quality of the Patient- Physician Relationship Among Terminally Ill African American and White Patients: Impact on Advance Care Planning.

Cardiovascular Disease Healthy Kansans 2010 Steering Committee Meeting April 22, 2005.

THE URBAN INSTITUTE Examining Long-Term Care Episodes and Care History for Medicare Beneficiaries: A Longitudinal Analysis of Elderly Individuals with.

How Much Do Patients’ Preferences Contribute To Resource Use? Anthony D L, Herndon M B, et al. Health Affairs, 28, no. 3 (2009):

Racial Disparities in Primary Care and Utilization of Health Services at the End-of-Life Andrea Kronman, MD Boston University School of Medicine.

Racial/Ethnic Disparities in Quality of Ambulatory Care for Chronic Physical Health Conditions: T he effects of physician and care setting characteristics.

Adverse Outcomes After Hospitalization and Delirium in Persons with Alzheimer Disease Charles Wang, PharmD Candidate.

Individualization Strategies for Older Patients with Diabetes Elbert S. Huang, MD MPH FACP University of Chicago.

The Relationship between Nativity Status, Satisfaction with and Confidence in Health Care Florence J. Dallo, PhD MPH Academy Health Meeting 9 June 2008.

The role of Coach in the Leadership Preventive Medicine Residency Dominic F. Geffken, MD, MPH ACPM February 24, 2006.

FUNCTIONAL STATUS PRESERVATION AND REHABILITATION Chartbook on Healthy Living.

Wins/Losses and Errors/Ties: Quality of Care for Acute Myocardial Infarction in the VA Health Care System Laura A. Petersen, M.D., M.P.H. 1 Sharon-Lise.

1 The Effect of Primary Health Care Orientation on Chronic Illness Care Management Julie Schmittdiel, Ph.D., Stephen M. Shortell, Ph.D., Thomas Rundall,

Accountable Care Organizations: What is the role of the pathologist? What are the public policy implications?

Helping older people live healthier lives through evidence-based prevention programs. 1.

ACS CAN Advocacy Update Jen Hunt, American Cancer Society Cancer Action Network (ACS CAN)

SAEM and Mentorship in Academic Emergency Medicine Andra L. Blomkalns, M.D. Vice Chair, Department of Emergency Medicine University of Cincinnati College.

The Role of LHDs in Improving Population Health LaQuandra S. Nesbitt, MD, MPH Director, LMPHW KHDA Retreat October 9, 2013.

Sustainability and Spread of Chronic Illness Care Improvement Shinyi Wu 1 M. L. Pearson 1, S. M. Shortell 2, P. J. Mendel 1, J. A. Marsteller.

The Effect of Hospitals’ Post-Acute Care Ownership on Medicare Post-Acute Care Use 1. Department of Family and Community Medicine, University of Missouri-Columbia.

M. Kay M. Judge, EdD, RN Marjorie J. Wells, PhD, ARNP.

Primary Care & Population Health Scholars Program Anthony J. Viera, MD, MPH UNC School of Medicine Gillings School of Global Public Health.

Caring for the expanding patient population Gero-Friendly Clinic Redesign Project Prepared for The Power of Community Health 15 th Annual Health Care Symposium.

Kelly M. Everard, PhD Sonia Crandall, PhD Amy Blue, PhD Fred Rottnek, MD David Pole, MPH Chip Mainous, PhD.

Testimony of U.S. Representative Allyson Schwartz Institutes of Medicine Committee on Geographic Variation in Health Spending and Promotion of High-Value.

Assessing Progress in End-of-Life and Serious Illness Care May 23, 2016.

Developing Global Family Medicine Faculty “de Novo” John G Halvorsen, MD, MS Professor Emeritus of Family and Community Medicine University of Illinois.

Career Development Awards Caroline Richardson, MD Erik Lindbloom, MD Michael Crouch, MD.

A Novel Faculty Development & Promotion Opportunity for Junior Clinical Track Physician Faculty Jean Malouin, M.D. M.P.H. James Peggs, M.D. Department.

Table 1: Patient Demographics

Cindy Hatton President & CEO Susan Levitt V.P. Clinical Services/COO

Claude Pepper Older Americans Independence Center

Trends in Stroke Rates, Risk, and Outcomes in the United States, 1988 to 2008 Margaret C. Fang, MD, MPH, Marcelo Coca Perraillon, MA, Kaushik Ghosh, PhD,

Establishing a career in Nutrition and Endocrinology

Presentation transcript:

Improving Care for Older Adults with Serious Illness Amy S. Kelley, MD MSHS Brookdale Leadership in Aging, 2009 Fellow Mount Sinai School of Medicine June 8, 2011

Aims of Brookdale Fellowship “ I aim to be a leader working to promote appropriate, preference-guided medical decision making for older adults” Research skills and mentored experience National discussion regarding policy to improve care Brookdale network

Aim: Examine the relationship between functional status and hospital use in the last 6 months of life. Participants: 2,493 Health and Retirement Study (HRS) decedents Data: HRS, Medicare claims and the Dartmouth Atlas. Outcome: Total hospital days in the last 6 months of life. Methods: Two-part regression models Adjust for patient characteristics, regional resources and hospital care intensity (HCI).

Patient CharacteristicsHospital Days, (95% CI) Functional Status, reference group Independent Stable, Severe (4-6 ADL) impairments 3.50 (0.41,7.26) Declined, Independent to Moderate 4.72 (2.31,7.63) Declined, Moderate to Severe 7.94 (4.97,11.91) Declined, Independent to Severe 9.13 (6.85,11.50) Race, reference group non-Hispanic white African American 6.13 (3.58,8.83) Hispanic 5.03 (1.49,9.44) Medical Conditions Alzheimer’s/Dementia (-4.18,-1.45) Chronic Kidney Disease 2.57 (0.94,4.30) Congestive Heart Failure 1.91 (0.51,3.50) Diabetes 2.48 (1.07,3.90) Stroke or TIA 2.10 (0.28,4.02) Relative Live Nearby (-2.87,-0.47) Hospice Admission within 6 months-1.89 (-3.25,-0.70) Hospital Beds per 10,000 residents in HRR (mean+1std vs mean-1std) 1.42 (0.07,2.83) Specialists per 100,000 residents in HRR (mean+1std vs mean-1std) 2.02 (0.64,3.35) Hospital Care Intensity Index (mean+1std vs mean-1std)2.23 (0.62,3.87) Characteristics Associated with Hospital Days in Last 6 Months

HRS Investigators meeting Drs. Ken Langa and Ken Covinsky Future efforts to improve the HRS for use in aging and palliative care research.

Evidence-based training in communication skills Funded by the National Cancer Institute Anthony Back, Robert Arnold, James Tulsky and Walter Baile GERITALK Intensive Communication skills training for Geriatrics and Palliative Medicine fellows Pilot tested Added to Fellowship Core Curriculum 2011

American Geriatrics Society Jr Faculty Research SIG steering committee Vice-Chair Mentoring Program Mentor-Mentee matches, biggest to date! Steering Committee Chair: Liaison to AGS Research Committee

Future Directions “ I aspire to be a leader in promoting high-quality preference-guided health care to older adults with serious illness.” Career Development Award Independent Investigator National role in shaping policy to improve care Clinical work in Geriatrics and Palliative Care Translate research to clinical / educational programs Teaching / Mentoring

Thank You Brookdale Foundation, Leadership in Aging Fellowship Mentors : Catherine Sarkisian, MD MSHS Sean Morrison, MD Susan Ettner, PhD Neil Wenger, MD, MPH