1 mental health & older adults: the wisconsin geriatric psychiatry initiative (wgpi) &...
TRANSCRIPT
11
Mental Health & Older Adults:Mental Health & Older Adults:The Wisconsin Geriatric The Wisconsin Geriatric
Psychiatry Initiative (WGPI) Psychiatry Initiative (WGPI) & &
“Star” Method“Star” Method
Linda Buel RNLinda Buel RNMay 8, 2009May 8, 2009
22
OverviewOverview
The public health crisisThe public health crisis Introduction of WGPI & the Star methodIntroduction of WGPI & the Star method Early resultsEarly results Outcomes measurement plan Outcomes measurement plan ReachReach
Issues – now and in 2030
Population aged 65 and older will increase from 20 million in 1970 to 69.4 million
Older adults with mental illness will increase from 4 million in 1970 to 15 million
Ratio of Geropsychiatrists to older adults - Ratio of Geropsychiatrists to older adults - 1:11,451 to 1:20,195 1:11,451 to 1:20,195
Jeste, Alexopoulus, Bartels, et al., 1999Association of Directors of Geriatric Academic Programs' "Status of Geriatric Workforce Study"Association of Directors of Geriatric Academic Programs' "Status of Geriatric Workforce Study"
Consequences
compromised quality of life increased morbidity and mortality-
increased service visits, increased burden to medical care providers, and heightened annual costs of care.
premature nursing home placement preventable hospitalizations
Bartels Stephen J, Michael A. Smyer, Mental Disorders of Aging: An Emerging Public Health Crisis?
55
Wisconsin Geriatric Psychiatry Initiative: Wisconsin Geriatric Psychiatry Initiative: Addressing Complexity in the Face of ScarcityAddressing Complexity in the Face of Scarcity
Goal: Goal: to enhance the delivery of mental health services to to enhance the delivery of mental health services to
older adults in Wisconsinolder adults in Wisconsin Methods:Methods:
indirect care via case-based consultative teaching indirect care via case-based consultative teaching sessions, using the Star Methodsessions, using the Star Method
more widely disseminate principles of geriatric more widely disseminate principles of geriatric psychiatry to different groups of providers: psychiatry to different groups of providers:
health care: medical and psychiatric health care: medical and psychiatric long-term carelong-term care aging networkaging network
network weaving: shaping an infrastructure via the network weaving: shaping an infrastructure via the strength of weak tiesstrength of weak ties
Dr. Tim HowellDr. Tim Howell
66
Determinants of HealthDeterminants of Health
(
Evans and Stoddart, 1990)
77
Understanding & Addressing Geriatric Understanding & Addressing Geriatric Problems: Problems:
The Wisconsin “Star” MethodThe Wisconsin “Star” Method
Symptom,Problem
MedicationIssues
Social Issues
Personal Issues(Personality)
PsychiatricIssues
Medical Issues
88
Early Results - 1Early Results - 1
Community Health Partnership report Community Health Partnership report PatientPatient
Dates of ServiceDates of Service Date of consultationDate of consultation
Activity beforeActivity before Activity afterActivity after
Early Results - 2Early Results - 2
Community Health Partnership reportCommunity Health Partnership report Patient Issues Team Issues
Organization Issues CT Session results
Changes after consult
1010
OutcomesOutcomes
BEFORE & AFTER SESSIONBEFORE & AFTER SESSION
Specific to this case how would you rate (the team) Specific to this case how would you rate (the team) in the following:in the following: -2-2 -1-1 00 11 22
InsightInsight
EnthusiasmEnthusiasm
ClarityClarity
MotivationMotivation
UnderstandingUnderstanding
Professional comfort re: how team is workingProfessional comfort re: how team is working
Professional comfort re: this current situationProfessional comfort re: this current situation
Level of hope about this memberLevel of hope about this member
Level of hope about his situationLevel of hope about his situation
1111
OutcomesOutcomes
To what extent do you agree that To what extent do you agree that the results of the Star Method the results of the Star Method affect patients':affect patients':
disagree disagree stronglystrongly
disagree disagree slightlyslightly
neither neither agree or agree or disagreedisagree
agree agree slightlyslightly
agree agree stronglystrongly
quality of lifequality of life
self-reported health statusself-reported health status
physical functionphysical function
emotional functionemotional function
1212
ReachReach
Milwaukee: CCO (PACE/Partnership/Family Care), Aurora Geriatrics, & ALM (CBRF)
Madison: Care Wisconsin, Family Services Eau Claire: CHP (Partnership/Family Care) AGS website: www.americangeriatrics.org San Antonio & Galveston TX (U Texas), Columbia MO
(U Missouri), Rochester MN (Mayo), Baltimore MD (Johns Hopkins), & Milwaukee (MCW): geriatric medicine fellowship programs (by speaker phone from Aurora Geriatrics)
Dr. Tim Howell
1313
AcknowledgementsAcknowledgements
Tim Howell, MD, MA; WGPITim Howell, MD, MA; WGPIGeriatric PsychiatristGeriatric PsychiatristAssociate Professor, UW Dept of PsychiatryAssociate Professor, UW Dept of Psychiatry
Cathy Swanson-Hayes - DHSCathy Swanson-Hayes - DHS Other members of the WGPI coalitionOther members of the WGPI coalition
University of Wisconsin Hospital & ClinicsUniversity of Wisconsin Hospital & Clinics