Education:
More than one thousand physicians, nurse practitioners and
registered nurses have participated in community-based geriatric educational
programs in the three states. Educational topics included the care of persons
who have less than one-year of life expectancy, the management of geriatric
emergencies, and the assessment of cognitive problems.
Effective January 1, 1997, retired New Hampshire physicians are able to offer pro bono consultation and education to the elderly. With increasing focus on efficiency of the health care system, busy clinicians find it difficult to spend extra time on patient education. The goal of this project is to develop and implement a program through which retired physicians are trained to provide focused health education and non-therapeutic consultative services "pro bono" to elderly residents in New Hampshire and Vermont, in particular the underinsured and impoverished.
The national American Association of Retired Persons (AARP) worked with Dartmouth's Rockefeller Center and the CFA to present policy questions in an informative and useful audiovisual format -- the "Intergenerational Video." The AARP was also instrumental in securing the passage of the "Pro Bono" legislation described above.
The Department of Veterans Affairs and the non-Veteran population now have available a videotape on Advance Care Planning and Living Wills developed with the assistance of the Center for the Aging.
The Center for the Aging and the Center for Improving the Care of the Dying at George Washington University have completed a national survey of the very old and an analysis of national data to address this question: Is there enough overuse of hospitals that reallocation within Medicare could provide sufficient funds to enhance home care and community services? The answer is yes. This policy research was supported by the Robert Wood Johnson Foundation.
The Emily Davie and Joseph S. Kornfeld Foundation, the National Cancer Institute and the New Hampshire Health Care Transition Fund have generously supported work to improve the care of the dying.
Elective Course - "The Dollars and Sense of Aging." This 8 hour course will distill Center for Aging clinical improvement expertise, its experience in providing education to large numbers of busy clinicians and lessons learned from an enduring and highly successful seminar series between College undergraduates and residents of a nearby retirement community. The aging elective will be coordinated with the 80+ project to enhance housestaff understanding of geriatric needs and methods to improve care.
Evaluation:
Wasson JH and Jette AM. A project designed to illustrate how understanding
the "patient world" can improve geriatric care in physicians' busy practice
settings. In: Netting FE and Williams FG, editors. Enhancing Primary Care
of the Elderly. Garland Publishing, Inc., New York. In press.
Wasson JH, Jette AJ, Johnson DJ, Mohr JJ, Nelson EC. A Replicable
and Customizable Approach To Improve Ambulatory Care and Research. J Ambulatory
Medicine 1997;20(1):17-27.
Fortinsky RH, Wasson JH. How Do Physicians Diagnose Dementia?
Evidence from Clinical Vignette. Amer J Alzheimer's Disease 1997; (12(2):
51-61.
Welch GH, Albertsen PC, Nease RF, Bubolz TA, Wasson JH. Estimating
treatment benefits for the elderly: the effect of competing risks. Annals
of Internal Medicine 1996;124(6); 577-584.
Nelson EC, Wasson JH, Johnson DJ, Hays RD. Dartmouth COOP Functional
Health Assessment Charts: Brief Measures for Clinical Practice. In: Spilker
B, ed. Quality of Life and Pharmacoeconomics in Clinical Trials. Philadelphia:
Lippincott-Raven, 1996:161-168.
Fortinsky RH, Leighton A, Wasson JH. Primary Care Physicians'
Diagnostic, Management, and Referral Practices for older persons and families
affected by dementia. Research on Aging 1995;17(2):124-147.
Because of the research focus of the CFA, evaluation is
built into most projects. Publications resulting from its work currently
include:
Wasson JH, Stukel TA, Weiss JE, Hays RD, Jette AM, Nelson
EC. A Randomized Trial of Streamlined Geriatric Care for Physicians' Offices
; submitted: JAMA, submitted.