Aging & Public Health
From the Editor
It must be the beginning of the school year. With the start of classes and return from vacations, it is always difficult to get people to send in material for the GHS Newsletter. This short edition is still with reading, as it contains updates on research and conferences, new reports on data released for analysis, and all the other stock and trade items of our profession. May you have a productive autumn.
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Update on Guided Care
Almost a year has passed since the GHS and the Archstone Foundation recognized Guided Care with the 2008 Award for Excellence in Program Innovation, and what an exciting year it has been! Scientific studies show that Guided Care improves the quality of care and suggest that it reduces overall health care costs, thereby generating much interest from health care providers, insurers, and federal policy-makers. In response, many resources are now available to help practices adopt Guided Care. Adding to that enthusiasm, Guided Care has been selected as the winner of the 2009 Medical Economics Award for Innovation in Practice Improvement co-sponsored by the Society of Teachers of Family Medicine, the American Academy of Family Physicians, and Medical Economics magazine.
Guided Care is a model of proactive, comprehensive health care provided by physician-nurse teams for people with several chronic health conditions. It is a type of medical home for the growing number of older adults with chronic health conditions. This model is designed to improve patients’ quality of life and care, while improving the efficiency of treating the sickest and most complex patients. Each care team includes a registered nurse, two to five physicians, and other members of the office staff who work together for the benefit of 50-60 patients to:
- Perform a comprehensive assessment at home.
- Create an evidence-based care guide and action plan.
- Monitor and coach the patient monthly.
- Coordinate the efforts of all the patient’s health care providers.
- Smooth the patient’s transition between sites of care.
- Promote patient self-management.
- Educate and support family caregivers.
- Facilitate access to appropriate community resources.
A multi-site, randomized controlled trial of Guided Care involving 49 physicians, 904 older patients and 308 family caregivers recently concluded in eight locations in the Baltimore-Washington, D.C. area. The three-year study was funded by a public-private partnership of the Agency for Healthcare Research and Quality, the National Institute on Aging, the John A. Hartford Foundation, the Jacob and Valeria Langeloth Foundation, Kaiser Permanente Mid-Atlantic States, Johns Hopkins HealthCare, and the Roger C. Lipitz Center for Integrated Health Care.
Results from the Guided Care randomized trial show that the model improved patients’ quality of care, reduced family caregiver strain, and produced high job satisfaction among participating nurses and physicians. New data indicate that Guided Care appears to reduce medical costs, resulting in an annual $1,364 savings per patient. Compared to patients who received usual care, Guided Care patients experienced, on average, 24 percent fewer hospital days, 37 percent fewer skilled nursing facility days, 15 percent fewer emergency department visits, and 29 percent fewer home health care episodes.
“Guided Care patients cost health insurers 11 percent less than patients in the control group,” says Chad Boult, MD, MPH, MBA, the principal investigator of the study and the Eugene and Mildred Lipitz Professor in Health Care Policy at the Johns Hopkins Bloomberg School of Public Health. “If you apply that rate of savings to the 11 million eligible Medicare beneficiaries, programs like Guided Care could potentially save Medicare more than $15 billion every year.”
Guided Care is a type of medical home where the physician-nurse team provides comprehensive, coordinated care to patients, the patients get involved in their own care, and the nurse tracks everything that happens to the patient. It is different from a typical medical home in that Guided Care only focuses on the high-risk patients, or the top 25 percent of patients with complex conditions.
“To implement a typical medical home, you really have to transform the whole practice and how everything gets done.” says Dr. Boult. “It could take years to put such a comprehensive type of medical home into place. In contrast, Guided Care is fairly easy to implement. You hire a registered nurse, put her through the Guided Care Nursing online course, integrate her into the practice, and you are running.”
With funding from the John A. Hartford Foundation, resources were developed and are now available to help practices adopt Guided Care. The book “Guided Care: A New Nurse-Physician Partnership in Chronic Care” is an implementation manual with many lessons learned, tools, and resources from the randomized trial. The Lipitz Center also provides: guidance on selecting health information technology, an online course for physicians and other practice leaders, and an online course for registered nurses in Guided Care Nursing. Nurses who successfully complete it will be eligible for a Certificate in Guided Care Nursing from the American Nurses Credentialing Center of the American Nurses Association. In addition, practices will be able to participate in ongoing learning communities and obtain individual consultation as desired.
For more information, please visit http://www.GuidedCare.org for details about Guided Care and http://www.MedHomeInfo.org for resources on becoming a Guided Care medical home.
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Active Aging Community Center
New online community advances active aging issues
Provides portal for researchers, practitioners
CHAMPAIGN, Ill.--The new online Active Aging Community Center, located at www.HumanKinetics.com/aacc, brings tools and information on older adult physical activity to all professionals and students interested in the the field.
The new community center, part of a greater HumanKinetics.com redesign, provides free access to tools and information such as news from international organizations, physical activity program successes, research findings, educational opportunities, job listings, conference and event calendars, grants and funding opportunities and member profiles.
"The ultimate goal of the Active Aging Community Center is advancing the study of active aging and enhancing the delivery of services to older adults worldwide," says Brian Holding, Human Kinetics CEO. Human Kinetics and the International Coalition for Aging and Physical Activity (ICAPA) sponsor the new community center, which is led by a steering committee of industry professionals, including renowned researcher Wojtek Chodzko-Zajko, PhD.
"We invite all professionals interested in the active aging field to join us on the site," says Active Aging Community Center director Angela DeMano. "Whether you'd like to report on news and happenings in your area, add conferences to the event calendar or share your work with members of the community, you're very welcomed to log on and join the dialogue."
In addition to the free content, the community center offers additional benefits to premium members through the "AACC+" portion of the site. Benefits to premium members include access to the international Active Aging Forum, product discounts, discounted registration for the 2012 Wold Congress on Active Aging and access to the new Active Aging Today multimedia journal. We are currently offering a free trial subscription; please visit http://www.humankinetics.com/products/all-products/Active-Aging-Community-Center-Plus-3-Month-Trial-Subscription to take advantage of this limited time offer.
"Active Aging Today is an exciting new project with great potential to invigorate our members' daily work," adds DeMano. "In addition to the content's usefulness to everyone from program directors and activity leaders to therapists and medical professionals, we think the way the content is presented -- including videos and podcasts as well as narratives and expert columns -- will better engage members.
Human Kinetics has served the physical activity field since 1974 as the premier publisher for physical activity and health products. Human Kinetics produces textbooks and their ancillaries, consumer books, software, videos, journals and online courses. Human Kinetics is based in Champaign, Ill., with subsidiaries in the United Kingdom, Canada and Australia.
The International Coalition for Aging and Physical Activity (ICAPA) is an international not-for-profit group of researchers and practitioners that promotes the study of active aging; the enhanced delivery of services to older adults; and the collection, dissemination, and discussion of information to help professionals further their work. Active aging is the process of leading an active life in order to optimize health, happiness, and autonomy as people age. ICAPA will organize a World Congress on Active Aging approximately every four years. The next Congress will be held in Glasgow, Scotland, in 2012.
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An American Association for Geriatric Psychiatry Maintenance of Certification Conference
An American Association for Geriatric Psychiatry Maintenance of Certification Conference:
Assessment & Management of Behavioral Symptoms in Patients with Dementia
Nov. 6-7, 2009
Marriott Baltimore Waterfront
This one-and-one-half-day conference will cover the psychiatry and neurology perspectives, non-pharmacologic interventions, and bioethics of caring for patients with behavioral symptoms in Alzheimer's disease and other dementias. Case-based presentations will provide interactive insight into dealing with clinical practice situations. Faculty and participants will review and discuss professional clinical guidelines to improve and optimize patient care. Helen H. Kyomen, MD, MS, of Harvard University, will chair and present the program. Other faculty include Stephen G. Post, PhD, of Stony Brook University; Teepa Snow, MS, OTR/L, FAOTA, who is in private practice; and Daniel G. Herrera, MD, PhD, of Brigham and Women's/Faulkner Hospitals. Physicians can earn up to 10.75 CME credits. An application to provide nursing CE credit will be filed with the Maryland State Nurses Association.
To learn more and register, please visit www.AAGPonline.org.
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Retirement Research Foundation Laurence G. Branch Doctoral Award
Esteban Calvo, PhD, is the recipient of the Retirement Research Foundation Laurence G. Branch Doctoral Award, 2009. The title of his paper is "Transitioning from work into retirement: Explaining well-being outcomes," and is co-authored by Natalia Sarkisian.
Calvo, Esteban. 2009. “The Impact of Public Pension Policy on Older Adults’ Life Satisfaction: An Analysis of Longitudinal Multilevel Data.” PhD Dissertation, Department of Sociology, Boston College,
Chestnut Hill, MA.
Calvo, Esteban, Kelly Haverstick, and Natalia Zhivan. 2009.“Determinants and Consequences of Moving Decisions for OlderHomeowners.” Working Paper #2009-16, Center for Retirement Research at Boston College, Chestnut Hill, MA.
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NYSBA Health Care Costs Report
New York State Bar Association
Health Law Section
Summary Report on Health Care Costs: Legal Issues, Barriers and Solutions
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HCUPs 2007 NIS Released
The Agency for Healthcare Research and Quality is pleased to announce the release of the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) featuring 2007 data. The NIS is the largest all-payer inpatient care database in the United States and is updated annually. It is available from 1988 to 2007, allowing analysis of trends over time.
The NIS is nationally representative of all short-term, non-federal hospitals in the United States. It approximates a 20 percent stratified sample of hospitals in the U.S. and is drawn from the HCUP State Inpatient Databases (SID) which include 90 percent of all discharges in the United States. The NIS includes all patients from each sampled hospital, regardless of payer — including persons covered by Medicare, Medicaid, private insurance and the uninsured.
The data can be weighted to produce national estimates, allowing researchers and policymakers to use the NIS to identify, track, and analyze national trends in health care utilization, access, charges, quality and outcomes. The vast size of the NIS enables analyses of infrequent conditions, such as rare cancers; uncommon treatments, such as organ transplantation; and special patient populations, like the uninsured. Its size also allows for the study of topics at both national and regional levels. In addition, NIS data are standardized across years to facilitate ease of use.
The 2007 NIS contains data from over 8 million hospital stays. It encompasses all discharge data from more than 1,000 hospitals in 40 states. For most hospitals, the NIS includes identifiers that allow linkages to the American Hospital Association's Annual Survey Database and county identifiers that permit linkages to the the Health Resources and Services Administration's Area Resource File. The NIS contains clinical and resource use information included in a typical discharge abstract, with safeguards to protect the privacy of individual patients, physicians, and hospitals (as required by data sources).
As part of the HCUP database family, the NIS is considered by health services researchers to be one of the most reliable and affordable databases for studying important health care topics.
The 2007 NIS can be purchased through the HCUP Central Distributor. Some 2007 NIS data are available in HCUPnet, a free online query system. More information about the NIS and other HCUP products can be found on the HCUP-US Web site. If you have questions, please contact HCUP user support at firstname.lastname@example.org.
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