Leading-Edge Medicine. Center for Geriatric Medicine

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1 Leading-Edge Medicine Center for Geriatric Medicine

2 To Heal. To Teach. To Discover. University Hospitals Case Medical Center Among the nation s leading academic medical centers, University Hospitals Case Medical Center is the primary affiliate of Case Western Reserve University School of Medicine, a nationally recognized leader in medical research and education. Our physicians and researchers many of whom also serve as faculty at Case Western Reserve University School of Medicine are leaders in their respective fields, and their ongoing clinical research programs push the boundaries of medical progress. Our strong emphasis on translational medicine means newly developed treatments and techniques transfer more rapidly from the research stage to life-enhancing patient care. This unified dedication to clinical research and education has played a major role in building UH Case Medical Center s rich legacy of landmark medical discovery, and continues to this day. Coupled with a commitment to implementing the latest therapies and advanced hospitals and community facilities, UH Case Medical Center offers a depth of care and scope of services unmatched by any other medical center in Ohio. Geriatric Medicine The Center for Geriatric Medicine at University Hospitals Case Medical Center is a collaborative program sponsored by the Departments of Family Medicine and Internal Medicine, and is devoted to the health and well-being of older adults. The center is a nationally recognized exemplar of hospital-, institution- and home-based geriatric care. Center for Geriatric Medicine 3

3 As chairman of the Department of Family Medicine, George Kikano, MD, CPE, FAAFP, oversees the Center for Geriatric Medicine at UH Case Medical Center. He was named on the 2009 Consumers Guide to Top Doctors and is a multiple-year honoree on Cleveland Magazine s Best Doctors list and America s Top Doctors. Dr. Kikano also serves on the board of directors of the Academy of Medicine of Cleveland and Northern Ohio and is the Dorothy Jones Weatherhead professor at the Case Western Reserve University School of Medicine. Peter DeGolia, MD, CMD, is director of the Center for Geriatric Medicine at UH Case Medical Center and medical director of the UH Hanna House Rehabilitation and Skilled Nursing Center, the A.M. McGregor Group, and the McGregor PACE Center for Senior Independence. He is also program director of the UH/Veteran s Administration Geriatric Medicine Fellowship Program. This nationally recognized expert in senior care was named to Cleveland Magazine s Best Doctors list in He is also an associate professor at the Case Western Reserve University School of Medicine, recipient of the Jack H. Medalie Chair in Home-Centered Health Care, board member of the McGregor Foundation and a Trustee-at- Large of the Western Reserve Area Agency on Aging. Leaders in Geriatric Medicine 4 University Hospitals Case Medical Center

4 Innovative Clinical Care 2011 and Beyond The Center for Geriatric Medicine at UH Case Medical Center is one of only six medical centers in the United States to participate in the Medicare Innovations Collaborative (MED-IC), a program to develop and apply best practices in geriatric medicine. MED-IC, formed in 2007 and funded by the Atlantic Philanthropies Foundation, has the goal of improving access to, and effectiveness of, geriatric care in the United States. Through MED-IC, UH Case Medical Center shares innovative programming, develops model senior care services and provides expertise to other health care providers that want to develop programs in senior care. The Center for Geriatric Medicine at UH Case Medical Center provides comprehensive care through these model programs: The Acute Care for the Elderly (ACE) program is a multidisciplinary-team approach to senior care that was developed at UH Case Medical Center to ensure high-quality, patientcentered care. The ACE team comprises a gerontologic clinical nurse specialist, a geriatrician, a social worker, pharmacist, rehabilitation therapist, dietitian and floor nurse. The center has facilitated the launch of ACE programs at two UH community hospitals: UH Bedford Medical Center and UH Richmond Medical Center. The UH Medical House Calls Program provides primary health care services to homebound adults who cannot otherwise access regular medical care. In three years, this program has doubled in size and now services 300 homebound seniors. In many instances the UH House Calls Program serves as the lifeline for frail and vulnerable elders. Led by Medical Director Karen Parker, MD, senior instructor, Case Western Reserve University School of Medicine, two full-time teams of physicians and nurse practitioners provide in-home continuity care with the intention of avoiding unnecessary emergency room visits and hospitalizations. The UH House Calls Program collaborates with other UH departments as well as community health service agencies to manage the care of vulnerable homebound seniors living in our community. Comprehensive Geriatric Assessment is an in-depth evaluation and review of the older adult focusing on geriatric syndromes, functional disabilities and the impact of medications on the health and well-being of the senior. This is a long-standing, highly valued program in which community physicians, older adults and their caregivers can obtain expert advice and care regarding the assessment of problems unique to seniors. Patients and caregivers work with a geriatrician, geriatric nurse, and geriatric social worker to comprehensively evaluate individual needs and concerns. Patients receive a full explanation of prescribed medications and how they affect the body, what to expect during diagnostic or treatment procedures and the results of tests, so that the patient and family can make informed decisions about care and treatment. Nurses Improving Care for Health System Elders (NICHE) is a national senior care initiative to improve the care of older hospitalized adults by developing nurses into geriatricresource specialists. Through the outstanding efforts of Catherine Roscoe-Herbert, CNS, CNP, DNP, University Hospitals Center for Geriatric Medicine is taking a national-lead by introducing NICHE to UH community hospitals UH Bedford Medical Center, UH Geauga Medical Center, UH Richmond Medical Center and St. John Medical Center and community nursing facilities. Through its participation in this program, UH Case Medical Center now has more than 50 geriatric-resource specialists and is improving senior care across the UH hospital system, nursing facilities and the home. Roscoe-Herbert also serves as coordinator of senior services and geriatric nursing leadership academy fellow. Palliative Care is an active and growing program that began in 2008 with 200 consultations and now has more than 600. The program focuses on supporting patients and families who suffer during their hospitalization. Led by Beth McLaughlin, MD, medical director, the UH Case Medical Center Palliative Care Consultation Service provides management of pain and other symptoms of suffering such as air hunger and severe nausea or constipation. Palliative Care also facilitates communication around goals of care to help ease stress and suffering during a hospitalization. Beneficial at any stage of an illness, it complements treatments that are meant to cure the patient. Dr. McLaughlin also serves as a senior clinical instructor at Case Western Reserve University School of Medicine. Skilled and Long-term Care Nursing Facility Collaboration. The UH Center for Geriatric Medicine works closely with UH Hanna House skilled nursing facility and several area nursing facilities to provide short-term and long-term skilled medical care. Our model of care emphasizes a collaborative partnership between geriatrician and gerontologic nurse practitioner. Care Transitions improves communication between University Hospitals facilities and community nursing home staff, as well as community physicians with the goal of improving transfers of patients between institutions and home. The center for Geriatric Medicine has developed rapid access programs at UH Case Medical Center, UH Bedford Medical Center and UH Richmond Medical Center to reduce dependence on emergency rooms while providing better care and service to patients and the community. PACE Program of All-inclusive Care of the Elderly allows geriatricians and gerontologic nurse practitioners from the UH Center for Geriatric Medicine to provide primary care to participants of the McGregor PACE program in Cleveland. This important home- and community-based program is a medical home for frail elders, designed to keep nursing home-eligible seniors out of nursing homes and help them continue to live in the community. It provides comprehensive medical, nursing, social services and rehabilitative care. University Hospitals is the contracted health system provider for all medical services of the McGregor PACE Center for Independent Living. Center for Geriatric Medicine 7

5 The commitment to exceptional patient care begins with revolutionary discovery. University Hospitals Case Medical Center is the primary affiliate of Case Western Reserve University School of Medicine, a national leader in medical research and education and consistently ranked among the top research medical schools in the country by U.S.News & World Report. Through their faculty appointments at Case Western Reserve University School of Medicine, physicians at UH Case Medical Center are advancing medical care through innovative research and discovery that bring the latest treatment options to patients. In concert with its clinical and academic activities, the Departments of Family Medicine and Internal Medicine conduct clinical research in areas such as cancer, chronic illnesses, cardiovascular disease, Alzheimer s disease, preventative care and physician-patient communications that will help primary care physicians and geriatricians better navigate patients through the ever-changing health care landscape. In 2009 the Department of Family Medicine at UH Case Medical Center and Case Western Reserve University School of Medicine ranked 12th in National Institutes of Health (NIH) funding for clinical research in the area of family medicine. Faculty are involved in five focal areas of research: primary care capacity for change, cancer prevention and health promotion, cancer epidemiology and gene-environment interaction, cultural competence, and doctorpatient communication. Discovering Tomorrow s Therapies The Division of General Internal Medicine focuses on Alzheimer s disease, quality of delivery and implementation of preventive services in specific areas of cancer screening, cardiovascular preventive care and diabetes care, improving the quality of patient care in the emergency room, and disparity in joint replacement in minorities. Center for Geriatric Medicine 9

6 Expanding for the Future The Center for Geriatric Medicine at UH Case Medical Center is continually expanding to better serve the older population in the Cleveland area, many of whom face barriers to health care such as mobility, expense and education. The UH/VA House Calls Program was awarded a $1 million grant from the Third Federal Foundation to expand the house calls program to the Slavic Village neighborhood of Cleveland, bringing quality in-home care to an underserved population. Over the past two years the house calls program has doubled to serve more than 300 homebound elderly persons in urban neighborhoods. In addition, the center received a $50,000 grant from the McGregor Foundation, a Cleveland-area nonprofit organization that supports the economically disadvantaged and frail elderly, to introduce NICHE into four nursing facilities. Training Tomorrow s Physicians The UH Center for Geriatric Medicine is the principal training center for students of the Case Western Reserve University School of Medicine seeking exposure to geriatric medicine. Through our collaboration with the Veteran s Administration Geriatric Medicine program, we train the largest number of Case Western Reserve University medical students in senior care. For the past three years, our geriatricians have taken every first year medical student on a half-day of home visiting in the Cleveland community. UH Family Medicine and Internal Medicine residents train in senior care with our medical staff. The center directs the UH/VA Case Geriatric Medicine Fellowship program, which provides additional in-depth training to physicians who plan to specialize in the care of older adults. Contributions to the Field The Center for Geriatric Medicine at UH Case Medical Center has helped shape the specialty of senior care throughout its history. UH Case Medical Center was the first site in the nation to have an ACE unit. Developed in 1994 by Dr. Seth Landefeld (now with UCSF-Mt. Zion Center on Aging), the ACE program s interdisciplinary team approach manages the care of complicated, fragile older adults who are at particularly high risk of iatrogenic complications complications caused by medicines or other treatments. For more than 20 years, the Memory and Cognition Center at UH Case Medical Center, a partnership between the Department of Family Medicine and UH Neurological Institute, has provided exemplary care for those affected with disorders of memory and cognition, such as Alzheimer s disease, Parkinson s disease, dementia and other disorders. This unique program affords patients the expertise of internationally known specialists who can treat the medical aspects of memory and cognitive disorders and aid in the emotional and family issues that are often a part of these diseases. Geriatric Medicine and the University Hospitals Case Medical Center Mission The Center for Geriatric Medicine is committed to fulfilling UH Case Medical Center s multifaceted mission: To Heal. To Teach. To Discover. The Center for Geriatric Medicine aims to meet the challenge as the number of older patients with more complex health needs increasingly outpaces the number of health care providers with the knowledge and skills to adequately care for them (Institute of Medicine, April 2008). The center is keenly focused on the comprehensive care of the elderly, and its innovative care methods serve as a model for family medicine programs across the nation. The center is also dedicating to educating tomorrow s health professionals today as the primary training resource in geriatric medicine for UH residents and Case Western Reserve University School of Medicine health professional students. The center offers a highly regarded Geriatric Medicine Fellowship training program for family physicians and internists interested in obtaining in-depth expertise in senior care. UH residents from Family Medicine and Internal Medicine rotate through all aspects of the senior care program. The UH/ VA geriatric medicine faculty precept the most Case Western Reserve University School of Medicine medical students as they rotate through their required Advance Core in Aging and Society clinical rotation. All first-year Case Western Reserve University School of Medicine medical students attend house call visits to gain firsthand experience in treating older patients in underserved populations. This past year UH Case Medical Center, the department and center collaborated closely with nursing leadership and educators of UH Case Medical Center to ensure a high standard of geriatric care across the hospital system. The nurse practitioner staff trains NP students in comprehensive senior care and palliative care. Catherine Roscoe- Herbert, coordinator of the Senior Service Initiative, is a fellow in the Geriatric Nurse Leadership Academy. 10 University Hospitals Case Medical Center

7 University Hospitals Case Medical Center Yesterday, Today & Tomorrow University Hospitals Case Medical Center has been at the forefront of patient care, physician education and medical research for more than 144 years. Founded after the Civil War as a place of healing, the institution embraced a broader role as medical science advanced. By the turn of the twentieth century, a modern general hospital was enhanced by specialty facilities for women, children and infants. An affiliation with the medical school of what was then Western Reserve University today Case Western Reserve University made University Hospitals of Cleveland one of the first true academic medical centers in the United States, joining Johns Hopkins Hospital and Massachusetts General in combining the training of young physicians and the pursuit of laboratory research with delivery of the most advanced patient care. In 1931, new facilities brought University Hospitals and the School of Medicine onto the same medical campus in University Circle. Over the years the complex continually expanded both its physical presence and the scope of its professional activities, adding diagnostic and treatment capabilities as well as top-flight physicians and surgeons. Eleven Nobel laureates have been affiliated with the medical center, helping to develop leading-edge treatments and therapies in such areas as heart disease, cancer, cystic fibrosis, neonatology and a host of subspecialties. Today, as the primary affiliate of Case Western Reserve University School of Medicine, the University Hospitals Case Medical Center boasts a strengthened relationship to research and teaching and a large academic medical campus that incorporates nationally acclaimed hospitals including UH Rainbow Babies & Children s Hospital, UH Seidman Cancer Center (formerly UH Ireland Cancer Center) and UH MacDonald Women s Hospital. In addition new institutes have emerged: The UH Neurological Institute, UH Harrington-McLaughlin Heart & Vascular Institute, UH Eye Institute, the UH Digestive Health Institute and the UH Urology Institute. The UH Case Medical Center campus, which provides patient-centered care with the most sophisticated diagnostic and therapeutic technologies, is augmented by a regional network of affiliated hospitals and suburban satellite locations. University Hospitals is putting the finishing touches on Vision 2010, a five-year, $1.2 billion strategic plan, which includes building the new freestanding 120-bed inpatient and outpatient UH Seidman Cancer Center; the Center for Emergency Medicine at UH Case Medical Center for adults and children; the Quentin & Elisabeth Alexander Neonatal Intensive Care Unit at UH Rainbow Babies & Children s Hospital, which was ranked fourth in the nation for newborn care by U.S.News & World Report; the new UH Ahuja Medical Center, a 435,000-square-foot hospital and 60,000-square-foot Kathy Risman Pavilion, the medical office building in Beachwood, Ohio; and several outpatient health centers throughout Northeast Ohio. A key strategy of Vision 2010 involves the implementation of a new state-of-the-art Electronic Medical Record System throughout the system. 12 University Hospitals Case Medical Center Center for Geriatric Medicine 13

8 Program for the All-Inclusive Care for the Elderly Clinicians & Scientists at UH Case Medical Center and Case Western Reserve University School of Medicine Center for Geriatric Medicine George Kikano, MD, CPE, FAAFP Chairman, Department of Family Medicine Dorothy Jones Weatherhead Professor Peter DeGolia, MD, CMD Director, Center for Geriatric Medicine Jack H. Medalie Chair in Home-Centered Health Care Associate Professor Ida Jahed, MD Assistant Professor Beth McLaughlin, MD Medical Director, Palliative Care Consultation Service Senior Clinical Instructor Swee Ng, MD, PhD Senior Clinical Instructor Evelyn Duffy, CNP, FAANP Associate Director, Center on Aging and Health Denise Brown, CNP Margaret Dragonette, CNP Courtney Gordon, CNP Cynthia Balina, MD Eric Baum, CNP Kelly Cervenka, CNP Barbara Moseley, CNP Elizabeth Fine, MD Medical Director, UH Foley ElderHealth Center Assistant Clinical Professor Karen Parker, MD, PhD Medical Director, UH Medical House Calls Program Senior Instructor Sandra Jorgensen, CNP Janice Mecklenburg, CNP Mariel Harris, MD, JD Medical Director, Hospice and Palliative Medicine at the Montefiore Home Assistant Professor Catherine Roscoe-Herbert, DNP Geriatric Nursing Leadership Academy Fellow Laura Morris, CNP

9 2011 University Hospitals BRA 00066