Standardized Self-Report Tools in Geriatric Medicine Practice: A Quality Improvement Study

Abstract Comprehensive geriatric assessment (CGA)—a multidimensional diagnostic process to determine medical, cognitive, and functional capacity—has historically included a narrative history supplemented by use of tools to assess domains such as mood or cognition based on assessor preference. This approach to CGA likely works to assess individuals but with increasing clinical complexity and frailty among older adults, a non-standardized approach may mean that key issues are not assessed, and program quality cannot be determined. The COVID-19 pandemic added to these challenges as social distancing practices meant limited face-to-face appointments and use of phone and video assessments. This quality improvement study implemented the interRAI Check-Up Self-Report instrument through a software platform in a specialized geriatric services practice. The instrument can be used over the phone and summarizes specific health problems and needs as well as information about caregiver status and financial trade-offs. Focus groups were also conducted with specialized geriatric services interprofessional team to explore their experiences with implementation. The descriptive analysis of the self-report data revealed expected geriatric issues, such as cognitive and functional impairment, falls and pain. Clients were also commonly experiencing medical instability, cardiorespiratory symptoms, communication impairments, and elevated risk for emergency department visit. Staff found the self-report tool feasible, easy to use, efficient, and the program-level metrics helpful for program planning. In conclusion, introduction of a standardized self-report enhanced CGA by creating a systematic method to flag, track, and prioritize all areas of need for immediate and future care planning at both the client and program level.

, pairing older adults with health professions students is an effective strategy to enable access to remote primary care and social connectedness.

of China), 2. National Cheng Kung University, Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (Republic of China) Objective measure of lifestyle of the older adults living in the community is void in the literature.To obtain both objective and subjective measurements to ascertain mobile and day and night lifestyle of older adults living in the community, and to build lifestyle model of older adults in the community by sociodemographic character.This study is a cross-sectional research.200 over-50-year older adults who own smartphone and live in southern Taiwan were interviewed.Wrist accelerometers to detect behavioral circadian rhythm, GPS app in smartphone to survey mobility, and questionnaire to assess psychological and social status.Preliminary finding of six participants (2 men and 4 women) was analyzed.Data show that participants about 60 years old have large discrepancies in comparison with participants in their 50s: lower sleep efficiency (73 vs 83), earlier Most active 10 hour midpoint (11.48vs 14.13 hour), higher interdaily variability (0.84 vs 0.75), wake after sleep onset (100.39vs47.78 minutes), and higher exercise frequency (4.33 vs 1.66 times per week).In addition, men have more chronic disease, bigger waistline (103.5 vs 77.5 cm), higher BMI (30 vs 22.5), lower middle to vigorous physical activity time (39 vs 79 minutes), and more total sleep time (356 vs 317 minutes).Age and sex seem to be significant factors determining lifestyle of older adults.Other sociodemographic parameters will be further analyzed.


STANDARDIZED SELF-REPORT TOOLS IN GERIATRIC MEDICINE PRACTICE: A QUALITY IMPROVEMENT STUDY

Melissa Northwood, 1 George Heckman, 2 Nicole Didyk, 1 Sophie Hogeveen, 1 and Amanda Nova, 2 1. McMaster University, Hamilton, Ontario, Canada, 2. University of Waterloo, Waterloo, Ontario, Canada Comprehensive geriatric assessment (CGA)-a multidimensional diagnostic process to determine medical, cognitive, and functional capacity-has historically included a narrative history supplemented by use of tools to assess domains such as mood or cognition based on assessor preference.This approach to CGA likely works to assess individuals but with increasing clinical complexity and frailty among older adults, a non-standardized approach may mean that key issues are not assessed, and program quality cannot be determined.The COVID-19 pandemic added to these challenges as social distancing practices meant limited face-to-face appointments and use of phone and video assessments.This quality improvement study implemented the interRAI Check-Up Self-Report instrument through a software platform in a specialized geriatric services practice.The instrument can be used over the phone and summarizes specific health problems and needs as well as information about caregiver status and financial trade-offs.Focus groups were also conducted with specialized geriatric services interprofessional team to explore their experiences with implementation.The descriptive analysis of the self-report data revealed expected geriatric issues, such as cognitive and functional impairment, falls and pain.Clients were also commonly experiencing medical instability, cardiorespiratory symptoms, communication impairments, and elevated risk for emergency department visit.

Staff found the self-report tool feasible, easy to use, efficient, and the program-level metrics helpful for program planning.In conclusion, introduction of a standardized self-report enhanced CGA by creating a systematic method to flag, track, and prioritize all areas of need for immediate and future care planning at both the client and program level.In the digital era, many electronic platforms have been established to facilitate patient-provider communication, such as e-mail, text messaging, and patient portal.The use of these electronic platforms is termed as electronic-communication (e-communication).E-communication has a variety of personalized healthcare functions, such as exchanging information, reviewing lab results, and facilitating patient engagement.However, little is known about the actual use of e-communication among older adults who are potentially major users of e-communication considering their high-level health care needs.Understanding their use of e-communication is critical in improving the application of e-communication in older adults.Using data from American Health Information National Trends Survey (HINTS2019-Cycle3; n=1,961; meanage =74.10, range=65-98), we explored: 1) the prevalence of e-communication use among older adults, and 2) factors affecting their use of e-communication.Variables were measured by self-reports.Weighted logistic regression with replicate weights provided by the HINTS was performed for data analysis.We found that 50% older adults reported the use of e-communication in the last year.Factors associated with higher likelihood of older adults' e-communication use included younger age (OR=09.96,95%CI=0.93-0.98,p<0.001), higher education (OR=4.82,95%CI=2.32-10.02,p<0.001 for college graduate or higher), higher income (OR=1.58,95%CI=1.05-2.38,p=0.030), comorbid conditions (OR=1.64,95%CI=1.02-2.64,p<0.001), and having a regular provider (OR=2.06,p=0.002).This study provided nationally representative results demonstrating a great potential use of e-communication in older adults.Special attention is needed to focus on socially vulnerable older adults (e.g., those with older age, lower education and income, and having comorbidity).The Yale New Haven Hospital Adler Geriatric Assessment Center is an outpatient consultative service that provides comprehensive assessment of older adults.As elsewhere, at Adler the COVID crisis necessitated a rapid shift in mode of care following a total cessation of in-person visits from late March 2020 to the end of May 2020.While our patients initially preferred telephone visits, video visits as a proportion of total scheduled increased from an average of 6% in the last full week of March to 24% in the last week in May possibly indicating increasing familiarity and comfort with the technology during that time.In addition, while video appointments as a proportion of total scheduled dropped rapidly in June 2020 as face-to-face appointments were reintroduced, we found a steady increase in the proportion of video visits from 3% in the first week of July 2020 to 7% in the second week of February 2021.To test for significance, we ran logistic regression models modelling the dichotomous video-appointment variable as the outcome and week and day of week as continuous variables.We found there was a significant increase in the proportion of appointments delivered over video both during the time when no face-to-face video appointments were allowed (OR=1.21,CI=1.13,1.30)and of China), 2. National Cheng Kung University, Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (Republic of China) Objective measure of lifestyle of the older adults living in the community is void in the literature.To obtain both objective and subjective measurements to ascertain mobile and day and night lifestyle of older adults living in the community, and to build lifestyle model of older adults in the community by sociodemographic character.This study is a cross-sectional research.200 over-50-year older adults who own smartphone and live in southern Taiwan were interviewed.Wrist accelerometers to detect behavioral circadian rhythm, GPS app in smartphone to survey mobility, and questionnaire to assess psychological and social status.Preliminary finding of six participants (2 men and 4 women) was analyzed.Data show that participants about 60 years old have large discrepancies in comparison with participants in their 50s: lower sleep efficiency (73 vs 83), earlier Most active 10 hour midpoint (11.48vs 14.13 hour), higher interdaily variability (0.84 vs 0.75), wake after sleep onset (100.39vs47.78 minutes), and higher exercise frequency (4.33 vs 1.66 times per week).In addition, men have more chronic disease, bigger waistline (103.5 vs 77.5 cm), higher BMI (30 vs 22.5), lower middle to vigorous physical activity time (39 vs 79 minutes), and more total sleep time (356 vs 317 minutes).Age and sex seem to be significant factors determining lifestyle of older adults.Other sociodemographic parameters will be further analyzed.

STANDARDIZED SELF-REPORT TOOLS IN GERIATRIC MEDICINE PRACTICE: A QUALITY IMPROVEMENT STUDY
Melissa Northwood, 1 George Heckman, 2 Nicole Didyk, 1 Sophie Hogeveen, 1 and Amanda Nova, 2 1. McMaster University, Hamilton, Ontario, Canada, 2. University of Waterloo, Waterloo, Ontario, Canada Comprehensive geriatric assessment (CGA)-a multidimensional diagnostic process to determine medical, cognitive, and functional capacity-has historically included a narrative history supplemented by use of tools to assess domains such as mood or cognition based on assessor preference.This approach to CGA likely works to assess individuals but with increasing clinical complexity and frailty among older adults, a non-standardized approach may mean that key issues are not assessed, and program quality cannot be determined.The COVID-19 pandemic added to these challenges as social distancing practices meant limited face-to-face appointments and use of phone and video assessments.This quality improvement study implemented the interRAI Check-Up Self-Report instrument through a software platform in a specialized geriatric services practice.The instrument can be used over the phone and summarizes specific health problems and needs as well as information about caregiver status and financial trade-offs.Focus groups were also conducted with specialized geriatric services interprofessional team to explore their experiences with implementation.The descriptive analysis of the self-report data revealed expected geriatric issues, such as cognitive and functional impairment, falls and pain.Clients were also commonly experiencing medical instability, cardiorespiratory symptoms, communication impairments, and elevated risk for emergency department visit.
Staff found the self-report tool feasible, easy to use, efficient, and the program-level metrics helpful for program planning.In conclusion, introduction of a standardized self-report enhanced CGA by creating a systematic method to flag, track, and prioritize all areas of need for immediate and future care planning at both the client and program level.In the digital era, many electronic platforms have been established to facilitate patient-provider communication, such as e-mail, text messaging, and patient portal.The use of these electronic platforms is termed as electronic-communication (e-communication).E-communication has a variety of personalized healthcare functions, such as exchanging information, reviewing lab results, and facilitating patient engagement.However, little is known about the actual use of e-communication among older adults who are potentially major users of e-communication considering their high-level health care needs.Understanding their use of e-communication is critical in improving the application of e-communication in older adults.Using data from American Health Information National Trends Survey (HINTS2019-Cycle3; n=1,961; meanage =74.10, range=65-98), we explored: 1) the prevalence of e-communication use among older adults, and 2) factors affecting their use of e-communication.Variables were measured by self-reports.Weighted logistic regression with replicate weights provided by the HINTS was performed for data analysis.We found that 50% older adults reported the use of e-communication in the last year.Factors associated with higher likelihood of older adults' e-communication use included younger age (OR=09.96,95%CI=0.93-0.98,p<0.001), higher education (OR=4.82,95%CI=2.32-10.02,p<0.001 for college graduate or higher), higher income (OR=1.58,95%CI=1.05-2.38,p=0.030), comorbid conditions (OR=1.64,95%CI=1.02-2.64,p<0.001), and having a regular provider (OR=2.06,p=0.002).This study provided nationally representative results demonstrating a great potential use of e-communication in older adults.Special attention is needed to focus on socially vulnerable older adults (e.g., those with older age, lower education and income, and having comorbidity).The Yale New Haven Hospital Adler Geriatric Assessment Center is an outpatient consultative service that provides comprehensive assessment of older adults.As elsewhere, at Adler the COVID crisis necessitated a rapid shift in mode of care following a total cessation of in-person visits from late March 2020 to the end of May 2020.While our patients initially preferred telephone visits, video visits as a proportion of total scheduled increased from an average of 6% in the last full week of March to 24% in the last week in May possibly indicating increasing familiarity and comfort with the technology during that time.In addition, while video appointments as a proportion of total scheduled dropped rapidly in June 2020 as face-to-face appointments were reintroduced, we found a steady increase in the proportion of video visits from 3% in the first week of July 2020 to 7% in the second week of February 2021.To test for significance, we ran logistic regression models modelling the dichotomous video-appointment variable as the outcome and week and day of week as continuous variables.We found there was a significant increase in the proportion of appointments delivered over video both during the time when no face-to-face video appointments were allowed (OR=1.21,CI=1.13,1.30)and later in the pandemic (OR=1.04,CI=1.02,1.06).Durbin-Watson statistics were run to ensure that autocorrelation could be ignored.Sensitivity analyses limiting the sample to those with non-cancelled appointments gave similar results.Future analyses will examine patient clinical and demographic characteristics that might influence these trends.

TELEMEDICINE UPTAKE IN A GERIATRIC ASSESSMENT CENTER DURING THE COVID CRISIS
TAKE IN A GERIATRIC ASSESSMENT CENTER DURING THE COVID CRISIS


THE 4MS OF AGE-FRIENDLY CARE: SUCCESSFUL INFUSION INTO ELECTRONIC MEDICAL RECORDS LEADS TO IMPROVED CARE Leah Tobey, and Robin McAtee, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States

Electronic Medical Records (EMR) and Health Information Technology (HIT) have changed the daily operations of the healthcare industry.For primary care systems/ clinics, it has meant the purchase and tailoring of systems to fit specific needs of users and patients.As one of the HRSA funded Geriatric Workforce Enhancement recipients, the AR Geriatric Education Collaborative (AGEC) worked with a rural federally qualified healthcare clinic system for over a year to help them become IHI certified in Age-Friendly Care and the EMR has been a critical link.The system was crucial in identifying compliancy to the clinical Merit-based Incentive Payment System (MIPS) measures which helped identify the areas where most improvement was needed.Included in the process was a new geriatric screening tab in the EMR system.This tab contains 8 screenings including: depression, anxiety, alcohol use, prescription opioid use and recreational drug use, mentation, medication and mobility.This is in addition to asking "what matters" so that all four of the 4M's age friendly framework components were included.Clinicians are successfully using the systems and improvements in outcomes are beginning to be noted.The outcome MIPS measures are obtained quarterly from an EMR report and

THE 4MS OF AGE-FRIENDLY CARE: SUCCESSFUL INFUSION INTO ELECTRONIC MEDICAL RECORDS LEADS TO IMPROVED CARE Leah Tobey, and Robin McAtee, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
Electronic Medical Records (EMR) and Health Information Technology (HIT) have changed the daily operations of the healthcare industry.For primary care systems/ clinics, it has meant the purchase and tailoring of systems to fit specific needs of users and patients.As one of the HRSA funded Geriatric Workforce Enhancement recipients, the AR Geriatric Education Collaborative (AGEC) worked with a rural federally qualified healthcare clinic system for over a year to help them become IHI certified in Age-Friendly Care and the EMR has been a critical link.The system was crucial in identifying compliancy to the clinical Merit-based Incentive Payment System (MIPS) measures which helped identify the areas where most improvement was needed.Included in the process was a new geriatric screening tab in the EMR system.This tab contains 8 screenings including: depression, anxiety, alcohol use, prescription opioid use and recreational drug use, mentation, medication and mobility.This is in addition to asking "what matters" so that all four of the 4M's age friendly framework components were included.Clinicians are successfully using the systems and improvements in outcomes are beginning to be noted.The outcome MIPS measures are obtained quarterly from an EMR report and data is shared with the staff and new quality improvement projects are developed using PDSA (plan, do, study, act) cycles based on the outcomes of the data.Next steps with the EMR will be the development of flags that will notify the clinicians when a screening is needed.