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IU GERIATRICSNEWS FROM THE INDIANA UNIVERSITY GERIATRICS PROGRAM& THE INDIANA UNIVERSITY CENTER FOR AGING RESEARCHSpring 2014Delivering Clinical Interventions and Developing Junior FacultyThe Aging Brain Care (ABC) Programincorporates the common features of severalevidence-based collaborative care models into oneprogram designed to deliver high quality,efficient medical care to older adults sufferingfrom dementia and/or depression. With the supportof a 3-year, 7.8 million CMS Health CareInnovation award, the services of the ABC programhave expanded from a small pilot of 200 patientsto serve more than 2000 Medicare and Medicaidbeneficiaries in central Indiana receiving primarycare services at Eskenazi Health or IU Health Arnett.Two areas of special focus for IU Geriatrics aredelivering clinical interventions and developing juniorfaculty. In this issue of our newsletter we highlight twonew projects selected by CMS for Health Care Innovation Awards, and nine junior faculty who have garneredcareer awards for academic development.The Aging Brain Care program, commonly referred toas the ABC Medical Home, is led by Malaz Boustani,MD, MPH (PI) and Michael LaMantia, MD, MPH; andOPTIMISTIC – Optimizing Patient Transfers, ImpactingMedical quality, and Improving Symptoms: TransformingInstitutional Care, is led by Greg Sachs, MD (PI),Kathleen Unroe, MD, MHA, and Arif Nazir, MD, CMD.Each of these clinical interventions aim to deliver betterhealth, improved care and lower costs to approximately2,000 seniors in central Indiana enrolled in Medicareand/or Medicaid; and both support primary care providers in the care of their complex older patients – ABCfor community dwelling people with depression ordementia, and OPTIMISTIC for dually eligible personsOPTIMISTIC - Optimizing Patient Transfers,Impacting Medical quality, and ImprovingSymptoms: Transforming Institutional Care,is a comprehensive program, building on evidencebased strategies, to collaborate with 19 centralIndiana nursing facilities to improve the qualityof care of long stay nursing facility residents andreduce avoidable hospitalizations. Funded by a4 year 13.4 million CMS Innovation Centercontract to Indiana University, the program is one of7 funded for CMS’s Initiative to Reduce AvoidableHospitalizations Among Nursing Facility Residents.residing in one of 19 nursing homes. These two projectsare the latest releases in a long line of innovations inprimary care designed and tested by clinicians andinvestigators of IU Geriatrics and the IU Center forAging Research, including IMPACT (Improving Mood –Providing Access to Collaborative Treatment; JAMA2002), PREVENT (Providing Resources Early toVulnerable Elders Needing Treatment for dementia;JAMA 2006), and GRACE (Geriatric Resources forAssessment and Care of Elders; JAMA 2007).One of the most gratifying roles Chris Callahan, MD andI have as Director of the IU Center for Aging Researchand Director of IU Geriatrics, respectively, is to facilitatethe career development of our junior faculty. Throughthe integration of all three academic missions – patientcare, education, and research – we have developedexciting opportunities for professional growth.Delivering clinical interventions and developing juniorfaculty get more exciting every year!Steven R. Counsell, MDMary Elizabeth Mitchell ProfessorDirector, IU GeriatricsApril 30, 2014
CMS Selects Two Local Programs for Health Care Innovation AwardsThe Centers for Medicare and Medicaid Services’ Health Care Innovation Awards fund organizations that are implementingprojects in communities across the nation that aim to deliver the most compelling new ideas to deliver better health,improved care and lower costs to people enrolled in Medicare, Medicaid and Children's Health Insurance Program, particularly those with the highest health care needs.The Aging Brain Care (ABC) ProgramThe clinical teams are supervised by a medical director withexpertise in dementia and depression management and aresupported by the eMR-ABC care coordination software.Much of the ABC intervention is targeted to co-manageor support the practice behavior of primary care cliniciansby providing personalized care aimed at improving the selfmanagement skills and coping behavior of both the patientand the informal caregiver.The eMR-ABC: creates a registry of all patients enrolled in the program tracks appointments alerts the care coordinators of any acute care visits monitors the current symptoms of the patients & informalcaregivers recommends individualized care protocols based on currentsymptoms provides timely feedback on the performance of the ABCprogram in managing the health and acute care utilizationof its populationThe program utilizes the concept of a “mobile office” which may include the patient’s or caregiver’s home may include any of the primary care or specialty clinics,the hospital, ER or any community setting takes into account the physical, emotional, and psychologicalcomfort of patients and caregivers when clinical staffschedule appointmentsEach team is led by an RN and a social worker who serve ascare coordinators and supervise care coordinator assistants(CCAs) who have at least a high school degree, are chosenfor their aptitude for working with vulnerable older adultsand receive additional training in the care of older adults withdementia and depression.Leadership, Project Team, Advisory BoardDirectors Malaz A. Boustani, MD, MPH, Lee Livin, MBA; Medical Director Michael LaMantia, MD, MPH; Manager CatherineAlder, JD, MSW; Leadership Core Malaz Boustani, MD, MPH,Lee Livin, MBA, Michael LaMantia, MD, MPH, ChristopherSteinmetz, MD, Kathy Frank, RN, PhD, and Catherine Alder,JD, MSW; Consumer Advisory Board is comprised of patients,families, and their advocates.The CCAs assist the care coordinators in assessing patientsymptoms and caregiver burden, delivering care protocols,monitoring medication adherence, managing data entry,scheduling patient and caregiver visits, and managing STIC - Optimizing Patient Transfers, Impacting Medical quality,and Improving Symptoms: Transforming Institutional CareNursing facility partners include independent facilities, aswell as regional and national chains.The primary outcome of OPTIMISTIC will be achievedthrough: proactive management of chronic conditions through structured care management reviews increased capacity to respond to changes in medical conditions through availability of additional resources includingRNs and NPs and through training in INTERACT tools optimized transitional care protocols a comprehensive advance care planning process improved access to palliative careStakeholder representation includes: Health Care Excel Indiana Area Agencies on Aging Health & Hospital Corporation State of Indiana Division of Aging LeadingAge Indiana Other community stakeholdersLeadership, Project Team and StaffDirectors Greg A. Sachs, MD, Kathleen Unroe, MD, MHA;Medical Director Arif Nazir, MD, CMD; IU Team Kathy Frank,RN, PhD, Michael LaMantia, MD, MPH, IU School of Nursing—Susan Hickman, PhD; Monica Tegeler, MD, Steve Counsell, MD, Greg Gramelspacher, MD, Greg Arling, PhD; Purdue—Noll Campbell, PharmD; University of Indianapolis—Ellen Miller, PhD; Project Staff Regenstrief Institute LauraHoltz, BS, CCRC, Helen Maurer, MA, CHES, Shaila Strayhorn,MPH, Connor Norwood, MHA; University of Indianapolis—Lidia DubickiThe program is supported by a project team with geriatricsand palliative care expertise, including 18 specially trained registered nurses stationed on-site at each nursing facility. Theyprovide direct support, and education and training to the facility staff; lead care management reviews of long-stay patients tooptimize chronic disease management; reduce unnecessarymedications; and clarify goals of care.Nurse practitioners support the OPTIMISTIC RNs, respondto urgent resident care needs, with evening and weekendavailability for in-person evaluation, and become site champions for training and leadership development.www.optimistic-indy.com2
IU Geriatrics Junior Faculty Garner Awards to Advance CareersFaculty mentors from IU Geriatrics and the IU Center for Aging Research are recognized nationally and internationally for theirexpertise in developing and advancing the academic and professional careers of our physician-scientists and clinician-educators.Their dedication is enriched and enhanced through the substantial resources awarded to our emerging leaders from entities suchas the National Institute on Aging, the US Department of Health and Human Services, the John A. Hartford Foundation and theNational Palliative Care Research Center.Todd James, MDArif Nazir, MD, CMDUS Department of Health and HumanServices, Health Resources and ServicesAdministration, Bureau of HealthProfessionsGeriatrics Academic Career AwardUS Department of Health and HumanServices, Health Resources and ServicesAdministration, Bureau of HealthProfessionsGeriatrics Academic Career AwardUS Department of Health and HumanServices, Health Resources and ServicesAdministration, Bureau of HealthProfessionsGeriatrics Academic Career AwardSeptember 2010 – August 2015September 2010 – August 2015September 2010 – September 2015Noll Campbell, PharmD, BCPPBabar Khan, MD, MSKofi Quist, MDNational Institute on AgingK23 Mentored Patient-Oriented ResearchCareer Development AwardJohn A. Hartford Foundation / IU Centerof Excellence in Geriatric MedicineHartford ScholarDelirium Biomarkers in the IntensiveCare UnitMedication Management Interventions inPatients Enrolled in GRACE Team CareApril 2014 – March 2019September 2012 – May 2017July 2013 – June 2015Tochukwu Iloabuchi, MD, MSMichael LaMantia, MD, MPHKathleen Unroe, MD, MHANational Institute on AgingK23 Mentored Patient-Oriented ResearchCareer Development AwardNational Palliative Care Research CenterJunior Faculty Career Development AwardElla H. Bowman, MD, PhDTraining Teams in Hospital to HomeTransitional Care Needs of Frail EldersNational Institute on AgingK23 Mentored Patient-Oriented ResearchCareer Development AwardEvaluating the Adverse Cognitive Effectof MedicationsJohn A. Hartford Foundation / IU Centerof Excellence in Geriatric MedicineHartford ScholarImproving Interdisciplinary Educationfor New Models of Team CareRisk Factors for Early Hospital Readmission Delirium Evaluation in the EmergencyDepartment for Seniors (DEEDS)in Low-Income Elderly AdultsJuly 2012 – June 2014Education Strategies for Improving Interdisciplinary Care of Nursing Home ResidentsUse of Hospice Services in Nursing HomesSeptember 2011 – September 2013April 2014 – March 2019IU Geriatrics — 33 Faculty Growing in ExcellenceDavid Bose, MD, CMDAssistant Professor of Clinical MedicineMedical Director, IU Health West HospitalAcute Care for Elders (ACE) Consult ServiceMedical Director, Wellbrooke of AvonGregory W. Arling, PhDAssociate Professor of MedicineScientist, IU Center for Aging ResearchInvestigator, Regenstrief InstituteResearch focuses on applied research that willimprove the effectiveness of health and long-termcare for older peopleInterests include acute care of the frail elderly,focused mainly on minimizing functional declinein the acute care settingEvelyn Bose, MD, CMDAssistant Professor of Clinical MedicineMedical Director, Eskenazi Health Extended CareMedical Director, IU Health Nursing Home ServiceMedical Director, Westside Village Health CareAdnan Arseven, MDAssociate Professor of Clinical MedicineMedical Director, Eskenazi Health Centerfor Senior HealthAssistant Program Director, Geriatric MedicineFellowshipInterests include post acute care, readmission reductionsand safe care transitions from hospital to SNF and SNF tohome; introducing palliative care with hospice to familiesin post acute care settingsInterests include improving quality of coordinated healthcare delivery to vulnerable older adults, and traininghealth professionals in the care of older adultsMalaz Boustani, MD, MPHRichard M. Fairbanks Scholar in Aging ResearchAssociate Professor of MedicineAssociate Director, IU Center for Aging ResearchInvestigator, Regenstrief InstituteChief Operating Officer, Center for HealthInnovation and Implementation ScienceChief Innovation and Implementation Officer,Indiana University HealthRobin A. Beck, MDAssociate Professor of Clinical MedicineAssociate Medical Director, Eskenazi HealthSenior CareMedical Director, Eskenazi Health CenterHouse Calls for SeniorsInterests include developing & improving clinicalprograms to provide excellent health care to frailolder adults across a continuum, focusing on thehomeboundResearch focuses on rapid translation of agingbrain research discovery into heath care delivery3
IU Geriatrics FacultyElla H. Bowman, MD, PhDAssistant Professor of Clinical MedicineMedical Director, Eskenazi Health Acute Carefor Elders (ACE) Consult ServiceTochukwu Iloabuchi, MD, MSAssistant Professor of Clinical MedicineInterests include care transitions for frail older adultsacross acute care settings, dissemination of bestgeriatrics practices through design and implementation of innovative curricular and education leadershipInterests include improving the care of frail hospitalizedpatients with multiple co-morbidities, educating learnersabout the hazards of hospitalization, hospital-to-homecare transitions, and palliative care/end of life issuesChristopher M. Callahan, MDCornelius and Yvonne Pettinga ProfessorDirector, IU Center for Aging ResearchInvestigator, Regenstrief InstituteTodd James, MDAssistant Professor of Clinical MedicineMedical Director, Eskenazi Health CenterGRACE / Bridge Care ManagementResearch focuses on social, clinical, and health systeminterventions to improve the care of older adults withdepression, dementia, and multimorbidityInterests include development of geriatrics andinterprofessional curricula, and improving carefor vulnerable seniorsNoll Campbell, PharmD, BCPPResearch Assistant Professor, Department ofPharmacy Practice, Purdue UniversityAdjunct Assistant Professor of Medicine, IUSMScientist, IU Center for Aging ResearchInvestigator, Regenstrief InstituteNiCole Keith, PhDAssociate Professor, IUPUI Department ofKinesiologyScientist, IU Center for Aging ResearchInvestigator, Regenstrief InstituteResearch focuses on the evaluation of the impactof health promotion activities on delaying decreasedfitness and functional decline.Research focuses on safety of medications andhealth systems interventions to improve the careof older adults in primary care settingsDaniel O. Clark, PhDAssociate Professor of MedicineScientist, IU Center for Aging ResearchInvestigator, Regenstrief InstituteBabar Khan, MD, MSAssistant Professor of Medicine,Division of Pulmonary MedicineScientist, IU Center for Aging ResearchInvestigator, Regenstrief InstituteResearch focuses on better understanding healthbehaviors; designing and evaluating programs tomeet the health promotion and self-managementneeds of adultsResearch focuses on long term outcomes of critically illpatients admitted to the ICU and developing a biomarkerprofile among delirious patients to predict long termcognitive, physical and psychological morbiditySteven R. Counsell, MDMary Elizabeth Mitchell ProfessorDirector, IU GeriatricsChief, Geriatrics Service Line, IU Health PhysiciansScientist, IU Center for Aging ResearchMichael LaMantia, MD, MPHAssistant Professor of MedicineScientist, IU Center for Aging ResearchInvestigator, Regenstrief InstituteMedical Director, Aging Brain Care Medical HomeResearch focuses on disseminating evidence-based modelsof care and influencing health policy to improve integrationof medical and social care to vulnerable eldersResearch focuses on coordination of care for older, vulnerable patients transitioning across sites of healthcare delivery,especially care in the emergency department and careprovided to seniors with delirium and dementiaTeresa M. Damush, PhDAssociate Research Professor of MedicineScientist, IU Center for Aging ResearchInvestigator, Regenstrief InstituteResearch Scientist, Indianapolis VAMC, HSR&DKristi Lieb, MDAssistant Professor of Clinical MedicineMedical Director, Northwest HealthcareInterests include dementia and long term care medicineResearch focuses on translating guidelines intopractice, evaluating implementation strategies tochange primary and specialty care practiceHugh C. Hendrie, MB, ChB, DScProfessor, Department of PsychiatryScientist, IU Center for Aging ResearchInvestigator, Regenstrief InstituteDouglas K. Miller, MDProfessor Emeritus of MedicineScientist, IU Center for Aging ResearchDistinguished Scientist, Regenstrief InstituteResearch focuses on epidemiology of cognitive andemotional health in the elderly and intervention trialsfor dementia and depressive disorders and for seriousmental illness in primary careResearch focuses on investigation of the causes andremediation of frailty and related health disparitiesin older African-Americans living in urban areas andthe emergency care of older adults4
IU Geriatrics FacultyArif Nazir, MD, CMDAssistant Professor of Clinical MedicineMedical Director, OPTIMISTIC ProjectMedical Director, Westpark Rehabilitationand Healthcare CenterMonica Tegeler, MD, CMDAssistant Professor of Clinical MedicineMedical Director, American VillageMedical Director, Harrison TerraceInterests include post-acute/long term care,palliative care, and behavioral symptomsin patients with dementiaInterests include providing expert care for frail & elderlypatients in the post-acute and long-term care setting.Research interests include dementia care, physicianengagement in nursing homes & nursing home qualityFelipe Perez, MDAssociate Professor of Clinical MedicineDirector, Geriatric Medicine FellowshipMedical Director, IU Health Methodist SeniorHealth Center and IU Health Methodist AcuteCare for Elders (ACE) Consult ServiceAlexia M. Torke, MD, MSAssociate Professor of MedicineAssociate Director, IU Center for Aging ResearchInvestigator, Regenstrief InstituteResearch focuses on ethics, communication, andpalliative care for older adults, especially those withcognitive impairment and dementia who are facingmajor medical decisionsInterests include development of new treatment strategiesfor dementia and other age-related diseases, focusing inthe molecular biology of aging and longevity pathwaysKofi Quist, MDAssistant Professor of Clinical MedicineMedical Director, IU Health MethodistGRACE Team CareWanzhu Tu, PhDProfessor of BiostatisticsScientist, IU Center for Aging ResearchInvestigator, Regenstrief InstituteInterests include medication management in olderadults and acute care of frail eldersResearch focuses on developing new statisticalmethods for clinical and epidemiological studiesGeetha Rao, MDAssistant Professor of Clinical MedicineKathleen Unroe, MD, MHAAssistant Professor of MedicineScientist, IU Center for Aging ResearchInvestigator, Regenstrief InstituteFaculty, RESPECT Center, Research in Palliativeand End-of-Life Communication and TrainingInterests include long term care medicine,teaching of residents/fellows and geriatriccurriculum developmentResearch focuses on policy relevant nursing home healthservices research in the areas of palliative and end of lifecare, workforce, and quality of medical careGreg Sachs, MDProfessor of Medicine and NeurologyChief, Division of General Internal Medicineand GeriatricsCo-Director, RESPECT CenterScientist, IU Center for Aging ResearchInvestigator, Regenstrief InstituteMichael Weiner, MD, MPHAssociate Professor of MedicineScientist, IU Center for Aging ResearchDirector, VA HSR&D Center for Health Informationand Communication; Health Services ResearchProgram at Regenstrief InstituteResearch focuses on measuring and improving qualityand delivery of health services for elders and the impactof health information in healthcareResearch focuses on ethical issues surrounding researchand clinical care involving people with
IU Geriatrics Junior Faculty Garner Awards to Advance Careers Faculty mentors from IU Geriatrics and the IU Center for Aging Research are recognized nationally and internationally for their expertise in developing and advancing the academic and professional car
