"We selected Aurora Health Care because of its track record in developing successful programmes for seniors and our belief in its commitment to expanding those programmes to meet the challenge of the changing health care needs of its community", stated Albert Siu, M.D., principal investigator of the collaborative study. Dr. Siu is professor and chairman of Geriatrics and Adult Development at the Mount Sinai School of Medicine in New York City.
"It's an honour to be included in this group of medical schools and health systems that are recognized for best practices in geriatric medicine", stated Michael Malone, M.D., medical director of Senior Services for Aurora Health Care. "We've been working the last 30 years to develop specialized care for seniors, and we look forward to sharing what we've learned."
Through the Medicare Innovations Collaborative, Aurora Health Care will provide technical expertise to other health care providers that want to develop an Acute Care for Elders programme. Known as ACE, the programme is in place on 28 medical-surgical units at Aurora's acute care hospitals.
In turn, Aurora hopes to tap into other providers' expertise in palliative care and to add a programme known as the Hospital Elder Life Programme, or HELP, designed for patients who are at risk for developing delirium. "The goal is for the collaborative to provide other health systems, medical schools and hospitals with a portfolio of programmes that could be the standard of care for older patients", stated Marsha Vollbrecht, Aurora's director of Senior Services.
Aurora's ACE programme is designed to help older adults maintain their mobility during a hospital stay, enable them to live independently at home after discharge, and minimize the amount of rehabilitation needed before they return home.
The Acute Care for the Elderly concept was developed in Cleveland and Akron, Ohio. The ACE programme was put in place at Aurora Sinai Medical Center in Milwaukee in September 2000, and later was expanded to 11 Aurora hospitals, improving outcomes for older patients throughout eastern Wisconsin.
The Aurora Senior Services team developed two new pieces for the ACE programme that are of particular interest to other health systems. The first is called ACE Tracker, a software integrated with electronic health records that helps identify vulnerable hospitalized seniors. These may include patients who are at risk of falls after they return home. Once the problem is identified, the ACE team intervenes, creating a treatment plan to address the patient's specific needs.
The second new component of ACE is "e-Geriatrician", which helps Aurora geriatricians perform "virtual rounds" via telemedicine. Geriatricians assist patients at Aurora's hospitals across eastern Wisconsin without the need for travel. They confer with a hospital's full interdisciplinary team, which includes a nurse facilitator, team nursing leader, case manager, nurse, pharmacist, physical therapist, dietitian, social worker and chaplain. The geriatrician then collaborates with the team to devise an appropriate, timely treatment plan.
"The collaborative was attracted to Aurora not only because of our success in developing this model of care, but also because of our ability to effectively spread that model to all of our sites", Dr. Malone stated. "Also distinctive was our work to incorporate ACE into our electronic health record system."
"Through ACE Tracker and e-Geriatrician, Aurora is able to reach thousands of seniors and improve their care", Dr. Malone stated.
As health care providers struggle to deal with a shortage of geriatricians throughout the country and improve access to care for an aging population, the "e-Geriatrician" and ACE Tracker programmes may provide part of the solution. The American Geriatric Society's AGS Foundation for Health in Aging projects that between 2010 and 2030, one in five Americans will be older than 65. Meanwhile, the number of certified geriatricians in the United States has declined from 8800 to 7100.
"That's what makes this project so vital", Dr. Malone stated. "Finding better, more efficient ways to care for the elderly is more important than ever."
In addition to Aurora, the other sites chosen to participate in the Medicare Innovations Collaborative are: Carolinas Health Care Systems/Carolinas Medical Center-Mercy, Charlotte, North Carolina; Crouse Hospital, Syracuse, New York; Geisinger Health Systems, Danville, Pennsylvania; Lehigh Valley Health Network, Allentown, Pennsylvania; and University Hospitals Case Medical Center, Cleveland, Ohio. The project is being funded by the Atlantic Philanthropies.
Michael Malone, medical director of Aurora Health Care's Senior Services, is an editor of the medical textbook "The Practice of Geriatrics", Fourth Edition. (Duthie E., Katz P., Malone M.L., editors. Elsevier Publishing Company, Philadelphia, Pennsylvania, June 2007.) He also is a professor of medicine for the University of Wisconsin School of Medicine and Public Health, and medical director of the Aurora Visiting Nurse Association of Wisconsin
Aurora Health Care is a not-for-profit Wisconsin health care provider and a national expert in efforts to improve the quality of health care. Aurora offers care at sites in more than 90 communities throughout eastern Wisconsin.