3 Aging Quality Education Quality of Life Quality Care Aging Q Fall Retreat September 25-26, 2009

Importance of Donald W. Reynolds grant to MUSC Aging is high profile issue in SC Aging is high profile issue in SC Demographic imperative Demographic imperative Opportunity to “Gerontologize” MUSC Opportunity to “Gerontologize” MUSC Potential broader impact on Primary Care (AHEC) Potential broader impact on Primary Care (AHEC)

Caring for older people is about Quality “The degree to which health care services for individuals and populations increase the likelihood of desired outcomes and are consistent with current professional knowledge” Institute of Medicine 1990

Characteristics of high quality of care Safe Safe Effective Effective Patient-centered Patient-centered Timely Timely Equitable Equitable Efficient Efficient

Quality of care for Vulnerable Elders: The canary in the coal mine

Aging Q 3 : Chronic Care Model

Aging Q 3 Organizational Chart rev. 9/1/09 Advisory Board John R. Feussner, Chair Raymond Greenberg John Raymond Jerry Reves Jeffery Wong Patrick Cawley David Garr Lotta Granholm Kathy Wiley Paul Eleazer Executive Committee William Moran - PI, Chair Jane Zapka, Co-PI, Evaluator Kathy Wiley Kimberly Davis Pamela Pride Patrick Mauldin Patty Iverson Brian Collins ACOVE Work Groups Vision - Bill Moran, Chair Falls and Mobility - Kathy Wiley, Chair Dementia - Pam Pride, Chair Continuity of Care - Kim Davis, Chair Urinary Incontinence Hospital Care/Transitions - Neal Axon, Chair Pharmacologic Mgmt - Amy Thompson, Chair Screening and Prevention–Elisha Brownfield, Chair End of Life Care - Paul Rousseau, Chair Osteoporosis Osteoarthritis Pain - Paul Rousseau. Chair Depression Pressure Ulcers Malnutrition Hearing Loss Evaluation Committee Jane Zapka, Chair William Moran Patrick Mauldin Yumin Zhao Patty Iverson Marketing Committee Patty Iverson Brian Collins USC Technical Support Team Paul Eleazer Darryl Wieland Maureen Bumba

Vision Loss Chair: Bill Moran, MD Member IP: Pam Pride, MD Member OP: Kathy Wiley, MD Member: Kim Davis, MD Consultant: Black, MD (Ophthal) 2. Falls and Mobility Chair: Kathy Wiley, MD Member IP: Cathryn Caton, MD Member IP: Cathryn Caton, MD Member OP: Member OP: Member: Cara Litvin, MD Member: Cara Litvin, MD Member: Amy Thompson, PharmD Member: Amy Thompson, PharmD 3. Dementia Chair: Pam Pride, MD Member IP: Neal Axon, MD Member OP: Jay Brzezinski, MD Member: Vanessa Spearman,MD Member: Vanessa Spearman,MD Continuity of Care Chair: Kim Davis, MD Member IP: Member OP: Member OP: Member: Member: 5. Urinary Incontinence Chair: Member IP: Member OP: Member: 6. Hospital Care & Transitions Chair: Neal Axon, MD Member IP: Member IP: Member OP: Member OP: Member: Paul Rousseau, MD Member: Paul Rousseau, MD 7. Pharmacologic Management Chair: Amy Thompson, PharmD Member IP: Member IP: Member OP: Member OP: Member: Member: Screening/ Prevention Chair: Elisha Brownfield, MD Member IP: Member OP: Member: 9. End of Life Care Chair: Paul Rousseau, MD Member IP: Member OP Member: 10. Osteoarthritis Chair: Cathryn Caton, MD Member IP: Member OP: Cara Litvin, MD Member: Member: 11. Osteoporosis Chair: Member IP: Member IP: Member OP: Leonard Lichtenstein, MD Member OP: Leonard Lichtenstein, MD Member: Member: Depression Chair: Member IP: Member OP: Member: 13/14. Pressure Ulcers Malnutrition Chair: Member IP: Member OP: Member: 15. Pain Management Chair: Paul Rousseau, MD Member IP: Member OP: Member: Member: 16. Hearing Loss Chair: Member IP: Member IP: Member OP: Member OP: Member: Member: Aging Q3 ACOVE Area and Work Groups

Vision Loss Chair: Bill Moran, MD Member IP: Pam Pride, MD Member OP: Kathy Wiley, MD Member: Kim Davis, MD Consultant: Black, MD (Ophthal) 2. Falls and Mobility Chair: Kathy Wiley, MD Member IP: Cathryn Caton, MD Member IP: Cathryn Caton, MD Member OP: Member OP: Member: Cara Litvin, MD Member: Cara Litvin, MD Member: Amy Thompson, PharmD Member: Amy Thompson, PharmD 3. Dementia Chair: Pam Pride, MD Member IP: Neal Axon, MD Member OP: Jay Brzezinski, MD Member: Vanessa Spearman,MD Member: Vanessa Spearman,MD Continuity of Care Chair: Kim Davis, MD Member IP: Member OP: Member OP: Member: Member: 5. Urinary Incontinence Chair: Member IP: Member OP: Member: 6. Hospital Care & Transitions Chair: Neal Axon, MD Member IP: Member IP: Member OP: Member OP: Member: Paul Rousseau, MD Member: Paul Rousseau, MD 7. Pharmacologic Management Chair: Amy Thompson, PharmD Member IP: Member IP: Member OP: Member OP: Member: Member: Screening/ Prevention Chair: Elisha Brownfield, MD Member IP: Member OP: Member: Member: 9. End of Life Care Chair: Paul Rousseau, MD Member IP: Member OP Member: 10. Osteoarthritis Chair: Cathryn Caton, MD Member IP: Member OP: Cara Litvin, MD Member: 11. Osteoporosis Chair: Member IP: Member IP: Member OP: Leonard Lichtenstein, MD Member OP: Leonard Lichtenstein, MD Member: Member: Depression Chair: Member IP: Member OP: Member: 13/14. Pressure Ulcers Malnutrition Chair: Member IP: Member OP: Member: 15. Pain Management Chair: Paul Rousseau, MD Member IP: Member OP: Member: Member: 16. Hearing Loss Chair: Member IP: Member IP: Member OP: Member OP: Member: Member: Aging Q3 ACOVE Area and Work Groups

Vision Loss Chair: Bill Moran, MD Member IP: Pam Pride, MD Member OP: Kathy Wiley, MD Member: Kim Davis, MD Consultant: Black, MD (Ophthal) 2. Falls and Mobility Chair: Kathy Wiley, MD Member IP: Cathryn Caton, MD Member IP: Cathryn Caton, MD Member OP: Member OP: Member: Cara Litvin, MD Member: Cara Litvin, MD Member: Amy Thompson, PharmD Member: Amy Thompson, PharmD 3. Dementia Chair: Pam Pride, MD Member IP: Neal Axon, MD Member OP: Jay Brzezinski, MD Member: Vanessa Spearman,MD Member: Vanessa Spearman,MD Continuity of Care Chair: Kim Davis, MD Member IP: Member OP: Member OP: Member: Member: 5. Urinary Incontinence Chair: Member IP: Member OP: Member: 6. Hospital Care & Transitions Chair: Neal Axon, MD Member IP: Member IP: Member OP: Member OP: Member: Paul Rousseau, MD Member: Paul Rousseau, MD 7. Pharmacologic Management Chair: Amy Thompson, PharmD Member IP: Member IP: Member OP: Member OP: Member: Member: Screening/ Prevention Chair: Elisha Brownfield, MD Member IP: Member OP: Member: Member: 9. End of Life Care Chair: Paul Rousseau, MD Member IP: Member OP Member: 10. Osteoarthritis Chair: Cathryn Caton, MD Member IP: Member OP: Cara Litvin, MD Member: 11. Osteoporosis Chair: Member IP: Member IP: Member OP: Leonard Lichtenstein, MD Member OP: Leonard Lichtenstein, MD Member: Member: Depression Chair: Member IP: Member OP: Member: 13/14. Pressure Ulcers Malnutrition Chair: Member IP: Member OP: Member: 15. Pain Management Chair: Paul Rousseau, MD Member IP: Member OP: Member: Member: 16. Hearing Loss Chair: Member IP: Member IP: Member OP: Member OP: Member: Member: Aging Q3 ACOVE Area and Work Groups

From Knowledge to Performance: Intervention Sequence for each ACOVE Faculty & intervention Development Resident Lecture Identify Patients at the time of care Cue MDs to act Provide decision support Record data on clinical intervention Assess performance: Extract and analyze Clinical data Resident Detailing

From Knowledge to Performance: Intervention Sequence for each ACOVE Faculty & intervention Development

Pic: Faculty lecture and Retreat Faculty & Intervention Development

From Knowledge to Performance: Intervention Sequence for each ACOVE Faculty & intervention Development Resident Lecture

From Knowledge to Performance: Intervention Sequence for each ACOVE Faculty & intervention Development Resident LectureResident Detailing

Detailing Sheets

Resident Detailing

From Knowledge to Performance: Intervention Sequence for each ACOVE Faculty & intervention Development Resident Lecture Identify Patients at the time of care Resident Detailing

Registration: ID Patients Identify Patients at the time of care

From Knowledge to Performance: Intervention Sequence for each ACOVE Faculty & intervention Development Resident Lecture Identify Patients at the time of care Cue MDs to act Resident Detailing

Blue Sheet Cue MDs to act

From Knowledge to Performance: Intervention Sequence for each ACOVE Faculty & intervention Development Resident Lecture Identify Patients at the time of care Cue MDs to act Provide decision support Resident Detailing

Provide decision support

Using Practice Partner to provide Decision Support This note version ONLY comes up for patients 65 and older

From Knowledge to Performance: Intervention Sequence for each ACOVE Faculty & intervention Development Resident Lecture Identify Patients at the time of care Cue MDs to act Provide decision support Record data on clinical intervention Resident Detailing

Record data on clinical interventions

Final Note in Practice Partner

Clinical performance data from Practice Partner

From Knowledge to Performance Faculty & intervention Development Resident Lecture Identify Patients at the time of care Cue MDs to act Provide decision support Record data on clinical intervention Assess performance: Extract and analyze Clinical data Resident Detailing

Synchronizing data collection and analysis