Background: The Acute Life Interventions Goals & Needs Program (ALIGN) at the Mount Sinai Hospital in New York City aims to work closely with high risk geriatric patients for short term intensive management of acute medical and social issues. Quantitative measures for determining success of the program is comparing emergency room visits and hospitalizations prior to and after enrollment with ALIGN. The Community Paramedicine service allows a paramedic, the ALIGN provider, and an emergency room physician to assess and triage patients in their home via video conference thereby avoiding ED visits for non-urgent services. Method: We reviewed the utilization of the Community Paramedicine service (from July 2017-February 2020) and its impact on ALIGN’s efforts to reduce unnecessary ED visits and hospitalizations. Results: 36 patients were evaluated with the Community Paramedicine service (from July 2017-February 2020). 19 or 52.8% avoided an ED visit and 17 or 47.2% were transported to the ED. 12 or 70.6% were admitted to the hospital of those that were transported to the ED initially. Top reasons for transport to ED included generalized weakness, acute mental status change (AMS), and shortness of breath (SOB). Conclusions: A Community Paramedicine program utilized by a high risk geriatrics team like ALIGN is effective in reducing ED visits and hospitalizations for the elderly population who incur greater expenses to the health care system and traditionally have poorer health outcomes.
The Geriatrics Preventable Admissions Care Team (GERIPACT) is an inter-professional team of 2 clinicians, 1 social worker, and 1 care coordinator, dedicated to offering temporary intensive ambulatory care services to complex older patients at high-risk for incurring expensive health care (ie. frequent emergency room visits or hospitalizations). GERIPACT services include frequent office visits for medical and social work needs, frequent telephone contact, home visits, specialty visit accompaniment, and a 24/7 telephone hotline. Use of this innovative model aims to serve communities lacking in geriatrician and geriatric social work providers, with a main goal of serving the highest risk older population. We reviewed the healthcare utilization of GERIPACT enrollees 6 months prior-to-enrollment and compared with 6 months following graduation from GERIPACT from 2016 to 2018. 78 patients were evaluated, with 49 total ED visits prior to enrollment and 35 post-graduation, saving 14 ED visits for a ratio of 18 saved ED visits per 100 GERIPACT patients. There were 45 hospitalizations prior to enrollment with 29 hospitalizations post-graduation, saving 16 hospitalizations, or 20 hospitalizations per 100 GERIPACT patients. Hospital days were reduced by 237 days post-graduation. An intensive ambulatory program for high risk geriatrics patients may be shown to be an efficient model of care for targeting those older patients who potentially incur greater expenses to the health care system. This focused team may be deployed to primary care communities with complex elderly patients in need of geriatricians and geriatric social workers, and may reduce unnecessary emergency room visits and inpatient stays.
Background Vaccines to prevent SARS-CoV-2 infection are deemed one of the most promising measures in controlling the devastating pandemic, yet there is significant vaccine hesitancy in some communities. Historic systemic health, discrimination, and structural inequities in specific racial and ethnic communities contribute to vaccine hesitancy with disproportionately negative impact. It is therefore critical to better understand vaccine hesitancy in this high-risk older population. The ALIGN (Acute Life Interventions, Goals, and Needs) program co-manages a panel of older patients with complex medical and psychosocial needs in an urban academic medical center. Methods ALIGN enrolled or graduated Patients or designated healthcare proxies were contacted by telephone to discuss SARS-CoV-2 vaccine willingness and hesitancy using a standardized web-based survey. Qualitative data was categorized into themes and subgroups. Demographic data was collected by chart review. Results Complete results are forthcoming and will include patient reported race and ethnicity baseline, vaccine hesitancy perceptions, with common overarching themes, and clinical team member debriefing. Iterative quality improvement actions taken based on elicited patient themes will also be included and assessed in telephone follow-up for changes in vaccine hesitancy. Conclusions We are conducting a qualitative and quality improvement study characterizing vaccine perceptions and hesitancy in a high-risk older group with focus on racial and ethnic disparities in this population. This preliminary data informs healthcare providers of potential health literacy, cultural and language, and other potential barriers in order to help further understand how to optimize SARS-CoV-2 vaccine acceptance and delivery in a patient population with elevated risk.
The Acute Life interventions Goals and Needs program(ALIGN) at Mount Sinai Hospital in New York City, is an inter-professional team dedicated to offering temporary intensive ambulatory care services to the most complex older patient population. This allows us to care for the most vulnerable population which often incur multiple hospitalizations, emergency room visits. Mr.C is a 81 yo male with past medical history of Chronic COPD, Depression, Gait instability, Mild Neuro-cognitive disorder, Hearing Loss, Coronary artery disease. Most significantly he had 3 ED visits, 1 admission, where he was found on the floor of his apartment after two days, by a meals on wheels volunteer. Team conducted a comprehensive assessment of Mr.C’s social determinants of health and compiled a care plan. We learned that Mr.C does not like to bother others therefore found it difficult to seek help. Team built intensive rapport and gained his trust to help simplify medications, increase engagement and explore barriers to home care. Mr.C was connected to several community agencies including, meals on wheels for more stable food access, psychiatry to discuss depression and isolation, adult protective services for deep cleaning,financial management, pharmacy for blister packing, home care services and case management to continue encouragement with care plan. Mr.C is now able to reach out to the team as needed and has a navigator to help with managing care. This is one of many cases ALIGN encounters, that often go undetected due to comprehensive inter-professional care needed and minimal time given in traditional primary care.
BACKGROUND: Traditional models of geriatric medicine and health system reimbursement structure often force ambulatory care teams to function as high-volume delivery programs, thereby dis-servicing our most vulnerable and frail older patients. This “high cost and high needs” labeled demographic requires uniquely adapted plans from medical and social work providers. METHODS: To better examine opportunities for improved framework for geriatric ambulatory care, the Acute Life Interventions, Goals & Needs (ALIGN) Program has launched several inter-professional pilot programs, each with intention to explore components of health care service to older patients, and feasibility of implementation in other health care systems. Three current models include the ALIGN Program itself, a telemedicine community paramedicine program, and a geriatric surgery co-management program. RESULTS: Preliminary results are forthcoming, with initial promising findings. For the first 126 patients enrolled, mean emergency room (ED) visits 6 months prior to ALIGN enrollment were 1.7 visits per person, reduced to 0.7 ED visits/person 6 months post-graduation from the program, and 126 fewer ED visits. Mean hospitalization 6 months prior to enrollment was 0.32 per person, whereas 6 months post-graduation was 0.2 hospitalizations/person, totaling 40.32 hospitalizations saved. Mean length of stay in the hospital 6 months prior to ALIGN enrollment for the 22 patients admitted was 7.7 days, reduced to 7.3 days post-graduation, and 32 fewer hospital days in the small subset of patients requiring hospitalization despite program interventions. CONCLUSION: The ALIGN Program’s multi-professional and flexible modularity highlights promising innovative frameworks for ambulatory geriatrics care, warranting further exploration and collaboration.
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