The After Discharge Care Management of Low Income Frail Elderly (AD-LIFE) Randomized Trial: Theoretical Framework and Study Design.
Aged; Frail Elderly; Study Design; Conceptual Framework; Health Care Delivery; Transitional Programs; Models; Theoretical; Treatment Outcomes; Multidisciplinary Care Team; Medical Practice; Poverty; 80 and Over; Evidence-Based; Chronic Disease – Therapy; After Care – Methods; Disease Management – Methods; Integrated – Methods; Randomized Controlled Trials – Evaluation
Interdisciplinary care management is advocated for optimal care of patients with many types of chronic illnesses; however, few models exist that have been tested using randomized trials. The purpose of this report is to describe the theoretical basis for the After Discharge Management of Low Income Frail Elderly (AD-LIFE) trial, which is an ongoing 2-group randomized trial (total n = 530) to test a chronic illness management and transitional care intervention. The intervention is based on Wagner's chronic illness care model and involves comprehensive posthospitalization nurse-led interdisciplinary care management for low income frail elders with chronic illnesses, employs evidence-based protocols that were developed using the Assessing Care of Vulnerable Elders (ACOVE) guidelines, emphasizes patient activation, and integrates with community-based long-term care and other community agencies. The primary aim of the AD-LIFE trial is to test a chronic illness management intervention in vulnerable patients who are eligible for Medicare and Medicaid. This model, with its standardized, evidence-based medical and psychosocial intervention protocols, will be easily transportable to other sites interested in optimizing outcomes for chronically ill older adults. If the results of the AD-LIFE trial demonstrate the superiority of the intervention, then this data will be important for health care policy makers. ( Population Health Management 2011;14:137-142)
Allen Kyle R; Hazelett Susan E; Jarjoura David; Wright Kathy; Fosnight Susan M; Kropp Denise J; Hua Keding; Pfister Eugene W
Population Health Management
2011
2011-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1089/pop.2010.0016" target="_blank" rel="noreferrer noopener">10.1089/pop.2010.0016</a>
The Promoting Effective Advance Care for Elders (PEACE) Randomized Pilot Study: Theoretical Framework and Study Design.
Ohio; Aged; Quality of Life; Health Care Costs; Pilot Studies; Practice Guidelines; Study Design; Conceptual Framework; Collaboration; Palliative Care; Depression; Goal-Setting; Disease Management; Multidisciplinary Care Team; Anxiety; Home Health Care; Chronic Disease – In Old Age – Ohio; Health Promotion – In Old Age – Ohio
Practice guidelines are available for hospice and palliative medicine specialists and geriatricians. However, these guidelines do not adequately address the needs of patients who straddle the 2 specialties: homebound chronically ill patients. The purpose of this article is to describe the theoretical basis for the Promoting Effective Advance Care for Elders (PEACE) randomized pilot study. PEACE is an ongoing 2-group randomized pilot study ( n = 80) to test an in-home interdisciplinary care management intervention that combines palliative care approaches to symptom management, psychosocial and emotional support, and advance care planning with geriatric medicine approaches to optimizing function and addressing polypharmacy. The population comprises new enrollees into PASSPORT, Ohio's community-based, long-term care Medicaid waiver program. All PASSPORT enrollees have geriatric/palliative care crossover needs because they are nursing home eligible. The intervention is based on Wagner's Chronic Care Model and includes comprehensive interdisciplinary care management for these low-income frail elders with chronic illnesses, uses evidence-based protocols, emphasizes patient activation, and integrates with community-based long-term care and other community agencies. Our model, with its standardized, evidence-based medical and psychosocial intervention protocols, will transport easily to other sites that are interested in optimizing outcomes for community-based, chronically ill older adults. ( Population Health Management 2012;15:71-77)
Allen Kyle R; Hazelett Susan E; Radwany Steven; Ertle Denise; Fosnight Susan M; Moore Pamela S
Population Health Management
2012
2012-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1089/pop.2011.0004" target="_blank" rel="noreferrer noopener">10.1089/pop.2011.0004</a>
MODELS AND SYSTEMS OF GERIATRIC CARE Developing a Stroke Unit Using the Acute Care for Elders Intervention and Model of Care.
BRAIN disease treatment; CEREBROVASCULAR disease; DISEASES in older people
The Acute Care for Elders (ACE) model of care is a multicomponent intervention that improves outcomes for older patients hospitalized for acute medical illnesses. Likewise, stroke units improve outcomes for patients with acute stroke, yet the descriptions of their structure and approach to stroke management are heterogeneous. The purpose of this article is to describe how implementing the ACE model of care, using a continuous quality-improvement process, can serve as a foundation for a successful stroke unit aimed at improving stroke care. The ACE intervention (a prepared environment, interdisciplinary team management, patient-centered nursing care plans, early discharge planning, and review of medical care) was amplified in a community teaching hospital for stroke-specific care by creating a stroke interdisciplinary team, evidence-based stroke orders and protocols, and a redesigned environment. Administrative data show that the ACE model can be successfully adapted to create a disease-specific program for stroke patients, having the potential to improve the process of care and clinical stroke outcomes. [ABSTRACT FROM AUTHOR]
Allen Kyle R; Hazelett Susan E; Palmer Robert R; Jarjoura David G; Wickstrom Glenda C; Weinhardt Jan A; Lada Robert; Holder Carolyn M; Counsell Steven R
Journal of the American Geriatrics Society
2003
2003-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Vitamin D supplementation to prevent falls in the elderly: evidence and practical considerations.
Humans; Aged; Patient Education as Topic; Pharmaceutical Services; Accidental Falls/*prevention & control/statistics & numerical data; Calcium/administration & dosage/therapeutic use; Cholecalciferol/administration & dosage/therapeutic use; Ergocalciferols/administration & dosage/therapeutic use; Vitamin D/administration & dosage/*therapeutic use; Vitamins/administration & dosage/*therapeutic use; 80 and over
Pharmacists in both ambulatory and institutional settings are often in a position to help optimize the drug regimens of patients who are experiencing falls. Supplementation with vitamin D is an important emerging therapy for the prevention of falls. Numerous investigators have recently studied or reviewed the association between vitamin D supplementation and decreased risk of falls in elderly patients, yet little of this information is available in the pharmacy literature. A MEDLINE search was conducted to collect relevant articles about the role of vitamin D in preventing falls among elderly patients; recently published meta-analyses and randomized controlled trials were identified and reviewed. The studies indicated a statistically significant positive relationship between vitamin D supplementation with either cholecalciferol 700 IU/day or greater or ergocalciferol 800 IU/day or greater and decreased risk of falls. Other practical issues, including who should receive vitamin D replacement, what form of vitamin D should be used, and what dosage is required to prevent falls, are discussed.
Fosnight Susan M; Zafirau William J; Hazelett Susan E
Pharmacotherapy
2008
2008-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1592/phco.28.2.225" target="_blank" rel="noreferrer noopener">10.1592/phco.28.2.225</a>
Results of the promoting effective advance care planning for elders (PEACE) randomized pilot study.
*Quality of Life; 80 and over; Activities of Daily Living; Advance Care Planning; Advance Care Planning/*organization & administration; Aged; Case Management – Methods; Chi Square Test; Community-Institutional Relations; Comparative Studies; Decision Making; Descriptive Statistics; Disease Management; Family; Female; Frail Elderly; Geriatric Assessment/methods; Health Promotion; Health Resource Utilization; Health Services for the Aged/organization & administration; Home Care Services/*organization & administration; Human; Humans; Interdisciplinary Communication; Long Term Care; Long-Term Care/*organization & administration; Male; Medicaid – Ohio; Multidisciplinary Care Team; Ohio; Outcomes (Health Care); Palliative Care; Palliative Care/organization & administration; Patient; Physicians; Pilot Projects; Pilot Studies – Ohio; Program Evaluation; Psychological Tests; Quality of Life; Random Assignment; Reference Values; Repeated Measures; Scales; Spiritual Care; T-Tests; Treatment Outcome
The specific aim of the PEACE pilot study was to determine the feasibility of a fully powered study to test the effectiveness of an in-home geriatrics/palliative care interdisciplinary care management intervention for improving measures of utilization, quality of care, and quality of life in enrollees of Ohio's community-based long-term care Medicaid waiver program, PASSPORT. This was a randomized pilot study (n=40 intervention [IG], n=40 usual care) involving new enrollees into PASSPORT who were \textgreater60 years old. This was an in-home interdisciplinary chronic illness care management intervention by PASSPORT care managers collaborating with a hospital-based geriatrics/palliative care specialist team and the consumer's primary care physician. This pilot was not powered to test hypotheses; instead, it was hypothesis generating. Primary outcomes measured symptom control, mood, decision making, spirituality, and quality of life. Little difference was seen in primary outcomes; however, utilization favored the IG. At 12 months, the IG had fewer hospital visits (50% vs. 55%, P=0.65) and fewer nursing facility admissions (22.5% vs. 32.5%, P=0.32). Using hospital-based specialists interfacing with a community agency to provide a team-based approach to care of consumers with chronic illnesses was found to be feasible. Lack of change in symptom control or quality of life outcome measures may be related to the tools used, as these were validated in populations closer to the end of life. Data from this pilot study will be used to calculate the sample size needed for a fully powered trial.
Radwany Steven M; Hazelett Susan E; Allen Kyle R; Kropp Denise J; Ertle Denise; Albanese Teresa H; Fosnight Susan M; Moore Pamela S
Population Health Management
2014
2014-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1089/pop.2013.0017" target="_blank" rel="noreferrer noopener">10.1089/pop.2013.0017</a>