Transcript Community-Based Partnerships

SAGE: A Unique Partnership
• Between Reynolds GET-IT
Program & Meals on
Wheels, Inc. of Tarrant
County
• Built on existing
relationship
• Meets needs of partnering
organization
The SAGE Program
The SAGE Program was modeled after the
University of South Carolina School of
Medicine/Palmetto Health Senior Mentor
Program, led by Paul Eleazar, MD. The
SAGE Program has been modified and
continually evolves to meet the needs of
UNT Health Science Center’s students.
The SAGE Program offers the unique opportunity for community seniors to receive in
home visits with medical school and physician assistant students.
Students get to see senior patients as people and not only as diseases, observe
challenges faced by elderly and how medical conditions impact quality of life & the
seniors’ coping mechanisms.
The SAGE Program
The SAGE program pairs two 1st or 2nd year medical school or physician assistant
students with a senior mentor/client that receives either home delivered meals through
the Meals on Wheels Program Inc. of Tarrant County or a senior in the community.
• Utilizes the blackboard system to post assignments and
discussion about each visit
• 25 PODs with 10-22 students in each POD. PODs get
to read each others assignments to see what others are
learning from their seniors.
• 16 SAGE Faculty Mentors that review, grade and
provide constructive feedback to students in their POD.
8 Visits over 2 Years….
Students are given the opportunity
to practice basic clinical skills &
interviewing.
Seniors receive blood pressure
checks, a limited physical exam, a
nutritional assessment, a home
safety assessment, community
resources, advanced care planning,
and companionship
Geriatric Minimum Competencies
SAGE assignments are integrated with the recommended minimum geriatric competencies
for medical students from the:
AGS American Geriatrics Society
Areas of Basic Competency for the Care of Older Patients
for Medical & Osteopathic Schools
AAMC Association of American Medical Colleges
Geriatric Competencies for Medical Students
AACOM American Association of Colleges of Osteopathic Medicine
Geriatrics Curricula for Undergraduate Medical Education in Osteopathic
Medicine
AOA American Osteopathic Association
Fundamental Osteopathic Medical Competencies
SAGE Curriculum
Session 1: Introduction to Senior Mentor/Client & Life
Reminiscence
Students learn to understand the benefits of life review, patient-centered interviewing, and
assessing psychosocial issues, spiritual beliefs, and health perceptions in older adults.
Elements of Recommended Minimum Geriatric Competencies Addressed:
Attitude Competencies
GERI-A-1
GERI-A-2
GERI-A-3
GERI-A-4
GERI-A-5
GERI-A-6
GERI-A-7
Awareness of Myths & Stereotypes
Recognition of Negative Aspects of Ageism on Optimal Care of the Elderly
Recognition of the Heterogeneity of Older Persons
Openness & Willingness to Work With Other Disciplines in Caring for Older Patients
Aging Self-Awareness & Personal Attitudes
Attitude of Compassion & Understanding for Care Givers of the Frail Elderly
Appreciation for Improving & Optimizing Functionality for Older People
AOA Competencies:
Interpersonal and Communication Skills
Professionalism
Session 2: Home Environment/Safety Assessment
Students learn to prevent conditions that could result in falls or other injuries and to perform a
comprehensive fall risk assessment for an older adult.
Elements of Recommended Minimum Geriatric Competencies Addressed:
Knowledge Competencies
(Clinical Practice, Psychosocial Issues & Geriatric Assessment)
GERI-K-11 Home Safety
GERI-K-12 Falls
GERI-K-13 Immobility & Gait Disturbances
Skills Competencies
GERI-S-2
Mobility Assessment
AOA Competencies:
Osteopathic Philosophy
Patient Care
Interpersonal and Communication Skills
Session 3: Medication/ Pharmacology
Students perform a medication review and learn to appreciate issues associated with
prescriptions and multiple medications.
Elements of Recommended Minimum Geriatric Competencies Addressed:
Knowledge Competencies
(Pharmacologic Changes Related to Aging)
GERI-K-2
GERI-K-3
Identify Drugs to be Avoided & Explain Potential Problems with Each
Inappropriate Prescribing of Meds
Skills Competencies
GERI-S-3
Document Patients’ Medication List
AOA Competencies
Medical Knowledge
Patient Care
Interpersonal and Communication Skills
Session 4: Medical History & Physiology of
Aging
Students obtain a medical history and practice communication skills with special emphasis on
physical changes of aging including questions about sexuality.
Elements of Recommended Minimum Geriatric Competencies Addressed:
Attitude Competencies
GERI-A-1
GERI-A-2
GERI-A-3
Awareness of Myths & Stereotypes
Recognition of Negative Aspects of Ageism on Optimal Care
Recognition of the Heterogeneity
Knowledge Competencies
GERI-K-17
GERI-K-29
GERI-K-53
Physiology of Aging
Normal Aging
Sexuality & Aging
AOA Competencies
Medical Knowledge
GERI-K-30 Anatomic & Histologic Changes of Aging
GERI-K-31 Pathology of Normal Aging
Patient Care
Interpersonal and Communication Skills
Visit/Session 5: Limited Physical Examination
Students perform a limited physical and cognitive examination on an older adult, including an
osteopathic structural exam. Students learn to adapt an examination to possible health
conditions.
Elements of Recommended Minimum Geriatric Competencies Addressed:
Skills Competencies (Geriatric Assessments)
GERI-S-2
GERI-S-8
GERI-S-4
GERI-S-9
GERI-S-7
GERI-S-9.1
Mobility Assessment
Social Functioning Assessment
Emotional Assessment
Assessment of ADL’s
Cognitive Assessment
Assessment of IADL’s
AOA Competencies
Osteopathic Philosophy and Osteopathic Manipulative Medicine
Patient Care Interpersonal and Communication Skills
Medical Knowledge
Professionalism
Visit/Session 6: Community Resources & Functional
Assessment
Students identify current use of community resources, potential services, identify
specific goals for the resources needed and complete a functional assessment.
Elements of Recommended Minimum Geriatric Competencies Addressed:
Attitude Competencies
GERI-A-4
Openness & Willingness to Work w/ other Disciplines
Knowledge Competencies
GERI-K-56 Community Resources
Skills Competencies
GERI-S-10 Development of Management Plan
AOA Competencies
Systems-Based Practice
Visit/Session 7: Nutritional Assessment
Students perform a nutritional assessment an provide education on nutritional balance and
diet modifications related to selected health conditions.
Elements of Recommended Minimum Geriatric Competencies Addressed:
Knowledge Competencies
GERI-K-58
GERI-K59
Primary Prevention
Secondary Prevention
Skills Competencies
GERI-S-9
GERI-S-10
Assessment of ADL’s
Development of Management Plan
AOA Competencies
Medical Knowledge
Patient Care
Interpersonal and Communication Skills
Visit/Session 8: Advance Care Planning &
Ending the Doctor/Patient Relationship
Students explore issues associated with advanced care planning (Power of Attorney, Living Will,
etc.) and learn the legal and ethical processes that take place with these decisions; and
identify the process for terminating the physician/patient relationship.
Elements of Recommended Minimum Geriatric Competencies Addressed:
Knowledge Competencies
GERI-K-14.2 Advance Directives
GERI-K-19 Palliative Care Based on ID of Patient’s Goals for Care
GERI-K-65 End-of-Life Care
AOA Competencies
Patient Care
Interpersonal and Communication Skills
Professionalism
In the Beginning
The SAGE program was started in the fall of 2009
with176 medical students and 136 seniors.
Year 2 2010 –
• 390 Students & 169 seniors recruited
Year 3 2011• 454 DO students & 69 PA students
• 141 Seniors Recruited
3rd Year
Currently, in its third year with 523 students and over
280 community seniors.
454 DO Students
69 PA Students
Evaluations
• 8 faculty graded
assignments
• Cannot pass Clinical
Medicine course w/o
passing SAGE
• Yearly evaluation on
students by their senior
mentor
Evaluation of Student by Senior Client
1. Is interested in me as a whole person?
2.
3.
4.
5.
6.
Is a good listener?
Is interested in my thoughts?
Understands my feelings?
Is eager to learn about aging?
Understands issues of quality of life for an older adult?
7. Understands the loss of independence is the most important
concern for the older adult?
Senior Clients’ Evaluation Comments of Students
Primary Strengths
Suggestions for Improvement
• Excellent demeanor & bedside
manner
• Good listener
• Professional
• Care about me as an individual
• Always listened and never tried
to hurry me
• Genuine Concern
• Plan ahead of time which
student would do what
• Be a little more assertive
• Time & practice is all they need
• Relax and have a less hurried
approach
• If your going to be late call
Student Comments
• I have learned a whole lot from
him, not just about medicine, but
about life.
• This session showed that often
times elderly patients are still
very healthy, sharp, and active,
and that age does not have to
come with a decline in health,
although there will be some
inevitable changes.
• Hands-on experience with patients
is something that I could use more
of and after this SAGE visit I feel
more confident about meeting new
patients & about taking their vital
signs.
• Not all older people are as
unhappy as the stereotype. This
was a useful session for both the
client and myself.
• This is a great experience for any
prospective physician.
DATA
Seniors
Number
Percentage
Total seniors
consented 2009-2011
463
100%
Active in Program
286
62%
Inactive
173
37%
On hold
4
<1%
Recruitment Sites
Data
Numbers
Percentage
Meals on Wheels
193
68%
PCC
58
20%
NW YMCA
13
5%
Community
6
2%
Jewish Senior Services
7
2%
Villa of Eastwood Terrace
4
1%
Casa Senior Center
3
1%
Tarrant Co Senior Citizens
2
<1%
Meals on Wheels, Inc of Tarrant Co.
• Served more than 14,881,997
meals in Tarrant County over
the past 38 years.
• Volunteer force of 3,500
delivers meals to 4,000 people
each year.
• Professional case manager who
assesses the client's needs,
coordinates services, and
advocates for the client with
other agencies..
Meals on Wheels Relationship
• Built on previous relationship w/ Project Investigator
• PI was on Board of Directors
• Meets the Needs of Partnering Agency
• Companionship for senior
• Safety Check
• Education
Partnership
• Agreement to recruit in place
• Orientation breakfast for social workers at MOW
• Overview of the SAGE program
• Review of paperwork
• Discussion of recruitment of seniors
• Originally, only limitation was geographic area
Senior Recruitment Challenges
Screening process in place 2nd year
• 40% of MOW seniors with some level of dementia
• Eliminate those with high level of cognitive disabilities
Geographic area expanded
Increase in student enrollment – increase in seniors
Maintaining the Relationship
1. Participate in monthly MOW social worker staff meetings
•
•
Provide breakfast to all 12 social workers at their meetings
In continuous contact w/ MOW concerning seniors welfare
2. We provide another set of eyes between social worker
visits
3. Ongoing support of seniors through:
• Phone calls & Emails
• Updating contact information
Side Effects of Partnerships
• APS Investigations
• Welfare Checks
• Community Resources
• Church involvement
• Exterminator Services
• Cleaning
Senior Client Retention
• Ongoing communication
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•
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Letters from Coordinator
Phone calls & monthly newsletters
Health Education material in folder
SAGE Card w/ BP readings
Medication Review Log
• Yearly certificates of participation
• End of year 2 pictures with seniors
Senior Client Loss
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•
•
•
•
•
•
•
Deaths
Dementia
Relocation
Nursing Homes
Hospice
Assisted Living
Decline in Health
Unknown
June 2011
What We’ve Learned in Recruiting
• First look at established relationship
• Look for senior sites
• (Patient Care Clinic at UNTHSC, silver sneakers programs,
Independent living facility, senior centers)
• Establish & build a relationship
• Attend Meetings
• Talk to stakeholders & key people
• Attend organized events
• Health fairs, classes, churches
Recruiting
• Assess the needs (companionship, opportunity to give
back, blood pressure checks, safety check)
• Develop common goal
• Talk & recruit seniors
• Provide continuous feedback
• Check progress of recruitment goal
• Maintain & expand if necessary
Oldest SAGE Senior 103!!
UNTHSC Reynolds GET-IT Program
• Janice Knebl, DO, MBA, FACP, FACOI, PI
• David Farmer, PhD Program Director
• Yolanda Pitts, MEd Educational Coordinator
• Freddy Cantu, Administrative Coordinator