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Purpose: A dynamic tension exists between preventing falls and optimally mobilizing hospitalized patients. The SAFER program aimed for patients, families, and staff to collaboratively design and simultaneously operationalize patient-specific fall reduction and mobilization strategies. Method: This pilot project was implemented on six units of a large level one trauma center. Patients were engaged in goal setting to maximize their mobilization potential while avoiding a fall during hospitalization. A poster displaying each patient's fall risk factors, corresponding mitigation strategies, and patient responsibilities served as a visual aid to assist staff, patients, and families in following the individualized safe mobilization plan. Falls and mobilization trends were measured. Results: This project achieved a 43% reduction in falls with a trend toward increased patient mobilization over a 6-month period. Conclusion: This project demonstrated a patient-centered approach to promoting safe mobilization within the context of the Age-Friendly Health Systems 4Ms Framework during hospitalization.

The purpose of this article is to describe 2 quality improvement projects aimed at embedding 2 of the 4Ms into the electronic health record for system-wide spread of Age-Friendly care. The 2 projects described in this case study serve as exemplars for the future implementation and sustainability of 4Ms care. Rapid-cycle quality improvement projects, via the Plan, Do, Study Act model, focused on the 4Ms were conducted by interprofessional teams to integrate clinical decision support for clinicians within the electronic health record. Project Senior Care Review for Evaluating and Eliminating Non-essential and potentially inappropriate medications (SCREEN) embedded a geriatric medication screen into the ordering panels of the top medications identified as being prescribed to older patients potentially inappropriately. Project Predictive Real-time Evaluation of Delirium in Clinical Therapy (PREDICT) embedded a delirium prediction rule in the electronic health records to guide clinicians to implement delirium mitigation interventions on patients at risk of developing or experiencing delirium. Outcomes were evaluated descriptively utilizing data and reports generated by the electronic health record. Embedding non-interruptive and actionable clinical decision support in the electronic health record supported the rapid spread of Age-Friendly care across a 7-hospital system. The 4Ms can be embedded into existing workflows through novel implementation of best practices by leveraging the electronic health record. By embedding 2 of the 4Ms into existing workflows and creating non-disruptive, actionable clinical decision support within the electronic health record, clinicians have the tools to implement Age-Friendly care within the 4Ms framework. Additional projects aimed at embedding the other Ms are underway, and long-term outcomes are being evaluated.

Abstract Background and Objectives Interprofessional education (IPE) is necessary to train health care professionals to work collaboratively for the care of older adults. Geriatric Outreach and Training with Care! (GOT Care!) was an innovative academic training program designed to provide an IPE opportunity for health care students and faculty while providing care to community-dwelling older adults. The objectives of this program evaluation were to: (a) examine students’, older adult participants’, and primary care providers’ (PCPs) perceptions toward their participation GOT Care! and (b) examine patient outcomes to identify program strengths and areas for improvement. Research Design and Methods Formative and summative program evaluation methods were utilized to evaluate student, older adult participant, and provider perceptions of participating in GOT Care!. A total of 221 pharmacy, physical therapy, nursing, social work, medicine, and public health students from a single public university in northeastern United States, 38 community-dwelling older adults, and 33 PCPs were included. Means, standard deviations, and percentages were computed for survey data. The contextual data gathered from interviews and open-ended questions were analyzed using Borkan’s immersion–crystallization approach to generate themes. Results Overall, the students, older adults, and PCPs appreciated GOT Care!. Students reported learning about the unique challenges to geriatric care and how to communicate with other professionals. The older adults appreciated the thorough interprofessional assessment and that the students could learn from them. The PCPs noted the unique insights into their patients’ health that would not present at a typical office visit. Discussion and Implications GOT Care! leveraged academic and community partnerships to provide an IPE opportunity and care to vulnerable older adults. Positive outcomes such as older adult, student, and PCP satisfaction, and a reduction in emergency department visits support ongoing utilization and evaluation of these IPE programs.

Palliative care improves quality of life for patients and families but may be underused. To assess the association of an intervention to increase social work staffing in Veterans Health Administration primary care teams with use of palliative care among veterans with a recent hospitalization. This cohort study used differences-in-differences analyses of the change in palliative care use associated with implementation of the Social Work Patient Aligned Care Team (PACT) staffing program, conducted from October 1, 2016, to September 30, 2019. The study included 71 VA primary care sites serving rural veterans. Participants were adult veterans who received primary care services from a site enrolled in the program and who received inpatient hospital care. Data were analyzed from January 2020 to August 2022. The PACT staffing program was a clinic-level intervention that provided 3-year seed funding to Veterans Health Administration medical centers to hire 1 or more additional social workers in primary care teams. Staggered timing of the intervention enabled comparison of mean outcomes across sites before and after the intervention. The primary outcome was the number of individuals per 1000 veterans who had any palliative care use in 30 days after an inpatient hospital stay. The analytic sample included 43 200 veterans (mean [SD] age, 65.34 [13.95] years; 37 259 [86.25%] men) and a total of 91 675 episodes of inpatient hospital care. Among the total cohort, 8611 veterans (9.39%) were Black, 77 069 veterans (84.07%) were White, and 2679 veterans (2.92%) were another race (including American Indian or Alaskan Native, Asian, and Native Hawaiian or other Pacific Islander). A mean of 14.5 individuals per 1000 veterans (1329 individuals in all) used palliative care after a hospital stay. After the intervention, there was an increase of 15.6 (95% CI, 9.2-22.3) individuals per 1000 veterans using palliative or hospice care after a hospital stay, controlling for national time trends and veteran characteristics-a 2-fold difference relative to the mean. This cohort study found significant increases in use of palliative care for recently hospitalized veterans whose primary care team had additional social work staffing. These findings suggest that social workers may increase access to and/or use of palliative care. Future work should assess the mechanism for this association and whether the increase in palliative care is associated with other health or health care outcomes.

Abstract The Veterans Administration (VA) Home-based Primary Care (HBPC) program provides comprehensive primary care to older Veterans with multiple chronic conditions who may be at risk of adverse health outcomes due to their social determinants of health. Area Deprivation Index (ADI) can be used as a surrogate measure of a Veteran's social needs. The objective of this study was to estimate the effect of neighborhood disadvantage, as measured by ADI, on HBPC enrollment for a sample of older Veterans. We estimated a linear multivariate model in which the exposure was ADI and the outcome was enrollment in HBPC. Controls included clinical and demographic characteristics. In a final sample of 12,005,453 observations (total Veteran months) on 353,485 individual Veterans, 18.4% lived in high-deprivation neighborhoods (ADI greater than or equal to 80). Mean monthly probability of new HBPC enrollment was 0.0061. Controlling for clinical characteristics, housing instability, and distance from the medical center, Veterans residing in high-deprivation neighborhoods were 1.4% to 14.8% less likely to enroll in HBPC, though the association was not statistically significant. The VA HBPC program provides beneficial comprehensive, primary care services to Veterans at risk of poor health outcomes. However, a Veteran's social determinants of health could prevent enrollment. More research is needed to determine the relationship between Veterans' social needs and HBPC enrollment.

Abstract Clinical trials show that palliative care improves patient experiences and reduces costs, and use of palliative care and hospice care have been increasing over the past three decades. In the Veterans Administration health care system (VA), Veterans may receive palliative care concurrently with other treatments. However, many barriers exist to the use of palliative care, such as patients' misperceptions. Social workers in primary care teams may increase use of this valuable service by establishing trust between patient and care team, educating patients and caregivers, and coordinating services. Leveraging a national social-work-staffing program as a natural experiment, we evaluated the effect of hiring one or more social workers to the primary-care team on use of palliative or hospice care among Veterans with a recent hospital stay. Our data included 91,675 episodes of care between 2016 and 2018. 1.45 percent of episodes were followed by use of palliative care or hospice within 30 days. The addition of one or more social workers through the staffing program was associated with an increase of 0.53 percentage points (p<0.001) in the probability of any palliative or hospice care, i.e., a more than 30% increase relative to the mean. Policy makers and health system leaders who seek to improve patient experience and reduce costs through increased access to palliative and hospice care could consider social work staffing as a policy tool to achieve those aims.

A dynamic tension exists between preventing falls and optimally mobilizing hospitalized patients. The SAFER program aimed for patients, families, and staff to collaboratively design and simultaneously operationalize patient-specific fall reduction and mobilization strategies. This pilot project was implemented on six units of a large level one trauma center. Patients were engaged in goal setting to maximize their mobilization potential while avoiding a fall during hospitalization. A poster displaying each patient's fall risk factors, corresponding mitigation strategies, and patient responsibilities served as a visual aid to assist staff, patients, and families in following the individualized safe mobilization plan. Falls and mobilization trends were measured. This project achieved a 43% reduction in falls with a trend toward increased patient mobilization over a 6-month period. This project demonstrated a patient-centered approach to promoting safe mobilization within the context of the Age-Friendly Health Systems 4Ms Framework during hospitalization.

Education modalities and platforms have rapidly adapted due to the effects of the C OVID-19 pandemic and new social distancing requirements. There are constant updates in the field of oncology related to treatment plans, clinical trials and specialty skills that require additional training for all members of the healthcare team. A study used social media for surgical training and found that the educational content had a significantly higher rate of engagement by those who followed it. Social media provides an efficient, immediate, accessible and inexpensive platform for oncology education that can enhance engagement by all members of the healthcare team. The purpose of this project was to implement a social media presence to provide education, advertisement of class offerings, and recognition to all members of the oncology team. Instagram was chosen as the social media platform for its ability to post videos, pictures, conduct polls, quizzes and more. The content is updated and provided by the educators of the Hartford Healthcare Cancer Institute. Content includes weekly learning moments, chemotherapy flashcards, and updates in practice. Team recognition, trivia, inspirational quotes, and reminders of class offerings are posted weekly through the Instagram story. In one month the Instagram account has gained 52 followers with different healthcare roles who practice in different settings. Qualitative feedback from staff has been favorable with staff reporting an increase in knowledge of different chemotherapies and interest in obtaining OCN certification due to the content posted. It is challenging to provide education only through emails and policy updates that have limited staff engagement. Creating an educational oncology Instagram account allows oncology educators to provide real-time updates of clinical information to staff. Next steps involve increasing our follower count and gathering data from polls and quizzes to tailor educational offerings and focus annual competencies on gaps that are identified from members of the HHC Cancer Institute team.

Abstract This study aims to assess the relationship between an Interprofessional Collaborative Practice (IPCP) intervention for community-dwelling older adults, Geriatric Outreach and Training with Care! (GOT Care!), and the observed 26% reduction in Emergency Department (ED) visits for the 51 older adults who participated. This study utilized a convergent parallel mixed-methods design that included a historical prospective matched cohort study and semi-structured interview surveys. The 51 GOT Care! participants were retrospectively matched to 51 control participants on several variables and ED visits were assessed for each group at 6, 8 and 12 months. Mixed effects generalized linear modeling, with a Poisson response, a log link function, and a random effect for pair, was conducted to analyze the quantitative data. Stakeholders, including hospital administrators and faculty clinicians, of GOT Care! responded to electronic semi-structured interview surveys regarding the relationship between GOT Care! and the observed reduction in ED visits. Content analysis of the responses was completed. The themes from the stakeholder interviews were integrated into the historical prospective matched cohort study to further explore the relationship between GOT Care! and the reduction in ED visits. The results of this study are still pending. This study has implications regarding the utilization of an IPCP model within an academic-practice partnership in the aim of reducing ED visits for vulnerable community-dwelling older adults. Hospital administrators can also utilize the results of this study to gauge the value of IPCP models within their hospital systems.

Clinical trials show that palliative care improves patient experiences and reduces costs, and use of palliative care and hospice care have been increasing over the past three decades. In the Veterans Administration health care system (VA), Veterans may receive palliative care concurrently with other treatments. However, many barriers exist to the use of palliative care, such as patients’ misperceptions. Social workers in primary care teams may increase use of this valuable service by establishing trust between patient and care team, educating patients and caregivers, and coordinating services. Leveraging a national social-work-staffing program as a natural experiment, we evaluated the effect of hiring one or more social workers to the primary-care team on use of palliative or hospice care among Veterans with a recent hospital stay. Our data included 91,675 episodes of care between 2016 and 2018. 1.45 percent of episodes were followed by use of palliative care or hospice within 30 days. The addition of one or more social workers through the staffing program was associated with an increase of 0.53 percentage points (p<0.001) in the probability of any palliative or hospice care, i.e., a more than 30% increase relative to the mean. Policy makers and health system leaders who seek to improve patient experience and reduce costs through increased access to palliative and hospice care could consider social work staffing as a policy tool to achieve those aims.