Slide 1 - Health Affairs

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Slide 1 - Health Affairs Powered By Docstoc
					ACE Tracker and e-Geriatrician
new models of care
Michael Malone, MD
Aurora Health Care
University of Wisconsin School of Medicine
    & Public Health
Milwaukee, WI
     ACE Tracker
                                                                                    • Acute Care for Elders (ACE) unit
                                                                                    was developed in 1995.
                                                                                    •A ten bed, ACE unit opened at
    ACE Tracker software to identify                                                Aurora Sinai Medical Center in
          vulnerable elders:                                                        2000.
                                                                                    •Unable to disseminate the ACE
                                                                                    unit model broadly.
                                                                                    •Electronic health record was
                                                                                    common to all hospitalized
                                                                                    •Developed software to provide a
                                                                                    real-time report to review each
Malone ML, Vollbrecht M, Stephenson J, et al, J Amer Geriatr Soc 2010: 58:161-167   patient’s plan of care.
                                                                                    •This computer-generated
                                                                                    checklist is available at all med-
                                                                                    surg units of all Aurora hospitals.
                                      • No geriatrician available in many
Aspirus Health Care                   rural hospitals.
                                      • Need to disseminate ACE concepts
                                      to sites no geriatricians on staff.
                                      • Single electronic health record led
                                      to the concept of using ACE Tracker
                                      at remote sites.
                                      •ACE unit interdisciplinary teams
                                      developed at remote sites.
                                      •Geriatricians build working
                                      relationships at teams at distant
                      Aurora Health
                      Care            • Geriatricians join interdisciplinary
                      geriatricians   teams for scheduled
                                      • Team recommendations are
                                      provided to medical staff at remote
ACE Tracker and e-Geriatrician
      Urinary Cath           •An example of a method to
                             disseminate a model of care
                             (ACE) to a population of seniors.
                             •33 ACE programs in 13 hospitals
                             in 2010.
                             •Avoided 3000 urinary catheters
                             per year (2006 vs. 2010 data).
 Physical Therapy
                             •Avoided an estimated 150
                             episodes of UTI and 7 sepsis per
                             •Avoided functional decline in an
                             estimated 830 seniors per year.
           Social Services
                             •Avoided new SNF placement of
                             an estimated 400 seniors per
                               The blue arrow notes the process
                              outcomes for the original ACE
                              randomized trials.
   Challenges and Next Steps:
• There is no mechanism to          •   Incorporate a mechanism to
  automatically tell the health         automatically guide the health
  care worker what to do if there       care worker what to do.
  is a vulnerability.               •   Track the patient’s functional
                                        trajectory across the sites of
• There is no baseline functional       care.
  status, prior to the hospital     •   Assess the feasibility and the
  admission.                            effectiveness of methods to
• We need a tool that can be            identify seniors at risk , as they
  used to track the patient’s           move from one site to another.
  functional status across the      •   Develop a standardized ACE
  sites of care.                        Tracker software across a
                                        network of three health care
• We need to develop further            systems (21 hospitals) in
  collaboration among multiple          Wisconsin.
  health systems.

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