Biomedical subjects

Janet C Frank

Publications and source records attributed to Janet C Frank.

9 recordsLinked to original sources

PubMed2006

Building institutional and faculty capacity in higher education gerontology academic programs.

Directors of California State University (CSU) gerontology, geriatrics, and aging studies (GGA) academic programs were surveyed regarding CSU capacity to fulfill demographic and legislative mandates to prepare professional personnel for work with the state's aging population. Program directors affirmed the importance of providing GGA education and training to meet these needs which will require GGA program growth in core and breadth courses, students, faculty, and scope. National guidelines for GGA program development and possible future accreditation and licensure were noted. The CSU currently does not support such growth. The number of GGA programs remained at 1997 levels and unevenly distributed across the state. Faculty time assigned to GGA was less than half of that presently required. Program directors rated GGAprogram and curriculum strength as modest, and CSU fiscal and administrative support as low. Program directors strongly supported faculty development innovations to prepare more present and future GGA faculty for building the capacity of higher education GGA programs.

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PubMed2004

Disciplinary split: a threat to geriatrics interdisciplinary team training.

In 1995, the John A. Hartford Foundation launched an initiative to strengthen geriatric interdisciplinary team training (GITT) for advanced practice nursing and masters-level social work students and residents in internal medicine and family practice. As part of the national evaluation of the initiative, case-study and cross-case designs were employed using quantitative and qualitative data to examine the influence of cultures, regulations, and attitudes of individual disciplines on interdisciplinary training efforts at the first eight GITT programs. This evaluation found that attitudinal and cultural traditions of the different health professions faculty and students (disciplinary split) remain as important obstacles to creating an optimal interdisciplinary team-training experience. In general, physician trainees participated least enthusiastically in GITT. In part, this lower level of enthusiasm may have been the result of inconsistent medicine faculty support of the program. At all but one program, physician trainees also had shorter GITT training experiences than other disciplines. In addition, the disparity in level of training by discipline of GITT participants may have contributed to attitudinal barriers to interdisciplinary training. Discipline-specific regulatory and accreditation barriers also impede interdisciplinary training. Nevertheless, GITT experiences at some clinical sites, especially home visits, appeared to promote interdisciplinary training. Some barriers to creating and implementing GITT programs may be best approached at the level of accrediting agencies and certifying organizations. Others will require local and national efforts of leaders in the different disciplines to model and support good team care.

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PubMed2004

Building academic geriatric capacity: an evaluation of the John A. Hartford Foundation Centers of Excellence initiative.

Almost 15 years ago, the John A. Hartford Foundation began its Centers of Excellence (CoE) program. In summer 2002, a quantitative and qualitative evaluation of the CoE program was conducted. The evaluation used previously collected quantitative data from surveys of program directors and graduates of fellowship programs, as well as interviews and surveys of currently funded CoEs. Since its inception, the CoE program has supported 163 geriatrics fellows, of whom 63% entered academic geriatrics. Almost half of these graduating fellows have gone to new academic institutions. CoEs have also supported 222 faculty, including some who were in disciplines other than geriatrics. The vast majority (82%) have remained in academics, and nearly two-thirds are currently in geriatrics. As the priorities and needs of the institutions and geriatrics programs changed, most centers shifted their CoE priorities. These changes predominantly took two forms: a refocus from one activity to another or an expansion of outreach or levels of support. Based upon this formal evaluation, the Hartford-supported CoE program has been successful in strengthening academic geriatrics, particularly in attracting, developing, and retaining geriatrics faculty.

California↗

PubMed2004

Preparing patients and caregivers to participate in care delivered across settings: the Care Transitions Intervention.

OBJECTIVES: To test whether an intervention designed to encourage older patients and their caregivers to assert a more active role during care transitions can reduce rehospitalization rates. DESIGN: Quasi-experimental design whereby subjects receiving the intervention (n=158) were compared with control subjects derived from administrative data (n=1,235). SETTING: A large integrated delivery system in Colorado. PARTICIPANTS: Community-dwelling adults aged 65 and older admitted to the study hospital with one of nine selected conditions. INTERVENTION: Intervention subjects received tools to promote cross-site communication, encouragement to take a more active role in their care and assert their preferences, and continuity across settings and guidance from a transition coach. MEASUREMENTS: Rates of postdischarge hospital use at 30, 60, and 90 days. Intervention subjects' care experience was assessed using the care transitions measure. RESULTS: The adjusted odds ratio comparing rehospitalization of intervention subjects with that of controls was 0.52 (95% confidence interval (CI)=0.28-0.96) at 30 days, 0.43 (95% CI=0.25-0.72) at 90 days, and 0.57 (95% CI=0.36-0.92) at 180 days. Intervention patients reported high levels of confidence in obtaining essential information for managing their condition, communicating with members of the healthcare team, and understanding their medication regimen. CONCLUSION: Supporting patients and caregivers to take a more active role during care transitions appears promising for reducing rates of subsequent hospitalization. Further testing may include more diverse populations and patients at risk for transitions who are not acutely ill.

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PubMed2003

Organizational issues in establishing geriatrics interdisciplinary team training.

The John A. Hartford Foundation-supported geriatrics interdisciplinary team training (GITT) initiative was a bold attempt to create a new educational agenda for the health professions. Although some components of GITT were previously in place at the eight institutions that participated in the Hartford initiative and at other institutions (e.g., Department of Veterans Affairs), never before has geriatrics interdisciplinary team training been so systematically planned, implemented, or evaluated. This paper focuses on four organizational factors essential to the establishment of a geriatrics interdisciplinary team training program: (1) organizational readiness to implement GITT, including the needs and existing resources of the organization; (2) partnerships, specifically the relationships between academic and clinical organizations; (3) institutional support, the tangible and intangible sources of support necessary at multiple levels within the organization; and (4) structure, the administrative and organizational requirements for team training programs. An analysis of these four factors and the influences upon them can help facilitate the successful implementation of interdisciplinary training programs at institutions considering this educational approach.

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PubMed2002

Guidelines for managing Alzheimer's disease: Part II. Treatment.

Once the clinical diagnosis of Alzheimer's disease has been made, a treatment plan must be developed. This plan should include cholinesterase inhibitor therapy to temporarily improve cognition or slow the rate of cognitive decline, management of comorbid conditions, treatment of behavioral symptoms and mood disorders, provision of support and resources for patient and caregiver, and compliance with state-mandated reporting requirements for driving impairment and elder abuse. The primary caregiver can be a valuable ally in communication, management of care, and implementation of the care plan. Patient symptoms and care needs change as Alzheimer's disease progresses. In the early stage of the disease, the family physician should discuss realistic expectations for drug therapy, solicit patient and family preferences on future care choices, and assist with advance planning for future care challenges. In the middle stage, the patient may exhibit behavioral symptoms that upset the caregiver and are difficult to manage. When the patient is in the advanced stage of Alzheimer's disease, the caregiver may need support to provide for activities of daily living, help in making a difficult placement decision, and guidance in considering terminal care options. Throughout the course of the disease, routine use of community resources allows care to be provided by a network of professionals, many of whom will be specialists in Alzheimer's disease.

Advance Directives↗

PubMed2002

Development and testing of a measure designed to assess the quality of care transitions.

BACKGROUND: To improve the quality of care delivered to older persons receiving care across multiple settings, interventions are needed. However, the absence of a patient-centred measure specifically designed to assess this care has constrained innovation. OBJECTIVE: To develop a rigorously designed and tested measure, the Care Transition Measure (CTM). SETTING: A large, integrated managed care organisation in Colorado with approximately 55,000 members over the age of 65 years. PARTICIPANTS: Patients 65 years and older who were recently discharged from hospital and received subsequent skilled nursing care in a facility or in the home. METHODS: Six focus groups of older persons and their caregivers (n=49) were established. Standard qualitative analytic techniques were applied to written transcripts and four key domains were identified: (1) information transfer; (2) patient and caregiver preparation; (3) self-management support; and (4) empowerment to assert preferences. Specific CTM items were developed, pilot tested, and refined. Psychometric testing, conducted in a different population but selected using the same entry criteria (n=60), included content and construct validity, intra-item variation, and floor/ceiling properties. RESULTS: Older patients and clinicians found the measure to be highly relevant and comprehensive (i.e. content validity). Construct validity was assessed by comparing items from the CTM to selected items from a measure developed by Hendriks and colleagues (Medical Care 2001; 39(3): 270-283). Inter-item Spearman correlations ranged 0.388-0.594. No significant floor or ceiling effects were detected. CONCLUSIONS: The CTM was developed with substantial input from older patients and their caregivers. Psychometric testing suggested that the measure was valid. The CTM may serve to fill an important gap in health system performance evaluation by measuring the quality of care delivered across settings.

Journal Article↗

PubMed2002

Guidelines for managing Alzheimer's disease: part I. Assessment.

Family physicians play a key role in assessing and managing patients with Alzheimer's disease and in linking the families of these patients to supportive services within the community. As part of comprehensive management, the family physician may be responsible for coordinating assessments of patient function, cognition, comorbid medical conditions, disorders of mood and emotion, and caregiver status. Suggestions for easily administered and scored assessment tools are provided, and practical tips are given for supporting primary caregivers, thereby increasing efficiency and quality of care for patients with Alzheimer's disease.

Activities of Daily Living↗

PubMed2002

Implementation of consultative geriatric recommendations: the role of patient-primary care physician concordance.

OBJECTIVES: To examine the effect on primary care physicians' implementation and their patients' adherence behaviors of patient-physician concordance about recommended geriatric health care. DESIGN: Case-series, independent interviews of patients and their physicians about their perceptions of the patients' health and the comprehensive geriatric assessment (CGA). SETTING: Community. PARTICIPANTS: Community-dwelling older patients (n = 111) who received consultative outpatient CGA and their primary care physicians. MEASUREMENTS: Concordance variables were generated using physician and patient responses to 10 questions on health- and CGA-related perceptions. An overall concordance score was generated by summing the total number of items on which patients and physicians agreed. Measures of the two dependent variables (physician implementation of and patient adherence to CGA recommendations) were by self-report. RESULTS: In multiple logistic regression analyses, overall concordance between patient and physician proved to be a significant and powerful predictor of physician implementation of (adjusted odds ratio (OR) = 2.7, 95% confidence interval (CI) = 1.6-4.6, P <.001) and patient adherence to (OR = 2.7, 95% CI = 1.7-4.2, P <.001) CGA recommendations, controlling for patient and physician gender and age, patients' functional status, duration of the patient-physician relationship, and frequency of visits in the previous year. Further analysis revealed that mutual patient-physician concordance on health-related perceptions was a significant predictor of these outcomes, whereas individual patient or physician perceptions were not. CONCLUSION: Concordance between older patients and their primary care physicians is a powerful predictor of physician implementation of and patient adherence to outpatient consultative CGA recommendations. Future research should focus on ways physicians can assess and negotiate patient-physician agreement on geriatric healthcare recommendations.

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