The Carolina Geriatric Workforce Enhancement Program is reaching out to primary care practices to ensure every provider has geriatrics knowledge.  The CGWEP has 5 clinical priorities:

1. Decreasing the incidence of falls in primary care and presenting to the emergency room
2. Increasing the use of advance care planning
3. Decreasing high risk medications like opioids and benzodiazepines
4. Improving the number of dementia caregivers who receive education and referrals to services
5. Decreasing the number of patients with out of control diabetes (A1C higher than 9)

 

Falls is a quality measure that has long been a goal of the CGWEP.  Between 2010 and 2015 we partnered with Mountain AHEC and Physical Therapy faculty from Western Carolina University to implement standardized falls risk screening for all patients over the age of 65 in 3 physician practices in the western part of North Carolina. In the summer of 2012 we reported an increase of 37% in falls screening rates showing a demonstrated improvement in practice and ultimately outcomes. Our research results were featured in 2 posters at the Gerontological Society of America.

Advance Care Planning: In Wilmington our partners at Southeast Area Health Education Center increased the number of older adults who have advance care planning conversations with their providers, scanned written documents in their electronic health records or a billed advance care planning visit. This project has been expanded to 51 clinics in the UNC Physicians Network.

Opioids and Benzodiazepines: With additional funding from the Centers for Disease Control the CGWEP has partnered with the UNC School of Pharmacy to reduce long term use of these medications that hold a higher falls risk for older adults.  This project will randomize primary care clinics into two arms.  The intervention clinics will receive additional consultation from expert Pharmacists from the UNC CAMP team while the control clinics will pursue usual care.  The research is expected to show a reduction in the prescribing of these drugs and perhaps a reduction in the rate of falls for patients at the intervention clinics.

Dementia Caregivers: In partnership with the NC Division of Aging and Adult Services the CGWEP has increased the number of caregivers being referred to the Family Caregiver Support Program across the state.

Diabetes: The CGWEP is partnering with Piedmont Health Services, Inc, a federally qualified health center that serves rural and low income patients to reduce the percentage of diabetic patients with out of control A1Cs.  Geriatricians, Family Medicine Physicians, Advance Practice Providers, Nurses and Nutritionists have teamed up to implement the American Diabetes Association Clinical App as part of this intervention.  Interprofessional healthcare providers will receive telementoring on managing their diabetic patients via a regular videoconferencing meeting with endocrinologists and other experts.

Bringing Age Friendly Healthcare to Continuing Care Retirement Communities (CCRCs)

In partnership with the John A. Hartford Foundation and the Institute for Healthcare Quality Improvement, the CGWEP is engaged with promoting the 4M’s of Age-Friendly Healthcare Systems at 3 CCRCs. The 4M’s include promoting mobility, safe medications, addressing mentation and paying attention to what matters to older adults.  Helping clinics quantify, document and improve these 4M’s will ensure more appropriate, patient centered care with the potential to save healthcare dollars.

Working with Emergency Medical Services

The CGWEP also trained a special team of EMS workers in Orange County on falls prevention. The Orange County Department on Aging has partnered with the CGWEP and EMS to create a service pattern network under which frequent fallers who call EMS have additional follow up. After the training EMS workers conduct a second home visit and perform a multifactorial falls risk assessment. Patients who screen positive receive follow up from a Case Manager at the Department on Aging who facilitate referrals and access to community services. This project not only represents another falls prevention intervention at another point on the service continuum but is also a change in service coordination and patterns linking agencies and health care providers in a much more coordinated system.

For more information on our research projects or to involve your doctor’s office, retirement home or community group email Cristine Henage, Ed.D.