ACADEMIC GERIATRICS ROTATION SCHEDULE



Models of Geriatric Care:

Rotation director: Cathleen Colón-Emeric, MD, 970-0235, VA x 6777

Overview:

This rotation provides practice experience with several models of care for frail or cognitively impaired older adults including homecare, Video-Telehealth Geriatric Consultations, Dementia Support Services (outpatient and home-based), Transitional Care Programs, Continuing Care Retirement Communities, PACE, community programs, Accountable Care Organizations, and Exercise and Mobility Programs for older adults.

General Learning Goals:

1) Collaborating with and leading multi-disciplinary teams engaged in providing care to frail older adults in a variety of settings and care models

2) Understanding the role of home care in frail and cognitively impaired older adults

3) Performing comprehensive evaluation and management of cognitive impairment, including diagnosis, pharmacologic treatment, behavioral management, caregiver training, and home safety assessments

4) Managing transitions of care in at risk older adults to reduce adverse events and unnecessary health care use

5) Understanding the role of physical activity in the maintenance of function in older adults, and providing an exercise prescription

Schedule:

1st month

|MON |TUES |WED |THURS |FRI |

| 8 AM |8-9AM |8-9AM Geriatrics Grand Rounds|8 AM |8 AM |

|COACH home visits (2-3 weeks)|Core curriculum Evidenced |Duke North Room 2001 |Long Term Care Rounds at TFAD|Medicine Grand Rounds |

| |Based Medicine, or Long Term | |or CV |Duke North Room 2002 |

|OR |Care Course | | | |

|STRIDE (1-2 weeks) | | | | |

| |9:30AM |9:30 CCRC | |9 AM |

| |COACH team meeting (2-3 |Clinic | |Geriatrics Fellows Conf. |

| |weeks) |Croasdaile** | |GRECC conf room VA (3012) |

|1 PM |1-3 PM |1 PM |1 PM |1 PM |

|Musculoskeletal Clinic (2 |VA Primary Care Clinic |Telehealth Consults |Long Term Care |VA Primary Care Geriatrics |

|weeks) OR |OR |OR |OR |Clinic |

|TLC Partners Home visits (2 |1:30 Duke Connected Care |Geriatrics PT/OT |Senior PharmAssist (2 weeks, |8B |

|weeks) |Geriatric Rounds |CLC gym |see pre-arranged dates in | |

| | |(2-3 weeks) |table) | |

**Notify Dr. White and the clinic at least 2 weeks before any planned absences

2nd month

|MON |TUES |WED |THURS |FRI |

| 8 AM |8-9AM |8-9AM Geriatrics Grand Rounds |8 AM |8 AM |

|CBOC PACT Geriatrics (2 |Core curriculum Evidenced |Duke North Room 2001 |Long Term Care Rounds at |Medicine Grand Rounds |

|weeks) |Based Medicine, or Long Term| |TFAD or CV |Duke North Room 2002 |

|OR |Care Course | | | |

|HBPC home visits (2 weeks) | | | | |

| |9AM |9 AM | |9 AM |

| |Gerofit Rounds (2 weeks, |PACE (4 weeks) | |Geriatrics Fellows Conf. |

| |9-10am) | | |GRECC conf room VA (3012) |

| |OR | | | |

| |Renal Silver (2 weeks) | | | |

|1 PM |1-3 PM |1 PM |1 PM |1 PM |

|CBOC PACT Geriatrics (3 |Telehealth Consults |PACE (4 weeks) |Long Term Care OR |VA Primary Care Geriatrics |

|weeks) |OR | |Senior PharmAssist (2 weeks,|Clinic |

|OR |VA Primary Care Clinic | |Aktolga only) |8B |

|HBPC home visits (3 weeks) | | | | |

Fellow Responsibilities:

1. Meet with rotation director week 1, final week of rotation, and as needed to set goals, review progress, and give/receive feedback.

2. Arrange clinical experiences with the contact provider. Arrive at clinical experiences on time.

3. Participate in/lead team meetings with the interdisciplinary team.

4. Document all clinical encounters as guided by faculty.

5. Seek feedback from colleagues regularly during the rotation.

Goals and objectives by experience: see table

Evaluation

Formative:

- Fellow will seek feedback from faculty and non-MD providers.

- Fellow will meet with Rotation Director at mid-point of the rotation to review objectives and progress toward achieving them.

Summative:

- Global evaluations collected from members of the interdisciplinary team and a composite evaluation is written by the Rotation Director.

- Fellow meets with Rotation Director to review performance and achievement of learning objectives.

- Fellow meets with Program Director to review evaluation.

Required Readings: see table

|Experience |Goals and Objectives |Logistics |Readings |

|COACH |Complete home assessments in the management of patients with |Judith Davagnino, SW, Judith.Davagnino@ VA x 6258. Review CPRS for |

| |cognitive impairment |patient information before home visit |short |

| |Practice caregiver education and support | | |

| |Understand the risks and benefits of pharmacologic and behavioral | | |

| |interventions for dementia with behavioral disturbance. | | |

|Croasdaile Clinic |Describe the financial model and care provided in a continuing care|Contact the clinic at least 2 weeks ahead of time if you are unable to | |

| |retirement community |attend. Address is 2600 Croasdaile Farm Parkway, follow signs to the | |

| | |clinic. Call 919 384-2571 for entry. Contact is Dr. White | |

| | |Heidi.white@duke.edu | |

|Duke Connected Care |Describe how accountable care organizations are funded, and how |Contact Dr. White Heidi.white@duke.edu |

| |services provided differ from fee-for-service Medicare |Duke Connected Care office, 718 Rutherford Street, Durham. Review cases |cleid=2290608&linkId=13941656 |

| |Participate in a population management program for high risk older |ahead of time in EPIC; list will be sent out to you via email the previous| |

| |adults |week | |

|Geriatrics PACT |Appreciate how geriatrics primary care differs from standard |Contact Dr. Soheili Kambiz.Soheili@ or pager (919) 970-6978. | |

| |primary care practices including staff:patient ratios and |Directions to the Raleigh CBOC, | |

| |coordination with care managers and IDT | | |

|Geriatrics PT/OT |Describe the roles of Physical, Occupational, and Speech Therapy in|Contact Phyllis Vandenberg ahead of time to arrange dates |

| |the care of post-acute and long-term care patients. |Phyllis.vandenberg@ |955056/ |

| |Determine the appropriateness of assistive devices for older adults| | |

| |with mobility impairments | | |

| |Describe commonly used adaptive equipment for older adults with | | |

| |functional impairments | | |

|Geriatric Video |Participate in evaluation and management of older patients with |Contact Megan Pearson (megan.pearson@) VA x 5323 for schedule of |

|Telehealth |geriatric syndromes using telehealth |consults |701960.2013.870902#.V17ObnLmrcs |

| |Describe how non-face to face models of care are implemented and | | |

| |evaluated within health systems. | | |

|Gerofit |Understand the relationship between physical activity and the |Email or call Adrienne Wagenblast |

| |development of functional impairment in older adults |Adrienne.Wagenblast@ to arrange an experience based on their |pii/S0003999311008173 |

| |Provide exercise prescriptions for older adults |schedule for new intakes/programs for the week | |

| |Understand the role of the exercise physiologist in geriatrics | |

| |research, education and patient care | |cleid=183892 |

|Home Based Primary Care |Collect functional and psychosocial information during home visits |Contact Linda (HBPC NP) 919 323-6866 or Carol (HBPC PA) 919 810-3612 |

| |Describe patient selection, team roles, and expected outcomes for a| |full.pdf+html |

| |home based primary care program | | |

|Musculoskeletal clinic |Diagnose and treat common musculoskeletal problems including |Email or page Dr. Kim Huffman (kim.huffman@duke.edu) to introduce yourself|

| |rotator cuff disorders, back pain, knee pain, and hip pain. |and let her know what weeks you will be coming |cleid=1899177 |

| |Develop proficiency in common joint and bursal | | |

| |aspirations/injections | | |

| |Use rehabilitation as a treatment modality for musculoskeletal | | |

| |disorders | | |

|PACE |List the enrollment criteria, funding, and appropriate patient |Karen Oldham koldham@ |

| |selection for PACE |Directions: |pii/S152586100800426X |

| |Identify how acute, post-acute, and chronic care are handled in the|''/durham+PACE+north+carolina/@35.9164586,| |

| |PACE model |-78.8434647,11z/data=!4m5!4m4!1m0!1m2!1m1!1s0x89ace555fb35e77b:0xdf5cf82d9| |

| | |e768d1b | |

|Renal Silver |Understand the role of geriatric assessment in serious chronic |Contact Rasheeda Hall Rasheeda.stephens@duke.edu |(add JAGS paper when published) |

| |disease management and advanced care planning | | |

|Senior PharmASSIST |List principles of appropriate prescribing in older adults |Specific dates have been pre-arranged: 7/7, 7/21, 8/11, 8/18, 9/22, 9/29, |

| |List factors that influence medication adherence in older adults |10/6, 10/13, 12/15, 12/29, 5/11/17, 5/25/17 |571677/ |

| |Work with a geriatric pharmacist in a multidisciplinary team |Contact Marilyn Disco if you cannot go to the dates in your block month | |

| | |Marilyn@ | |

| | |Directions: | |

| | | |

| | |201,+Durham,+NC+27701/@35.9993638,-78.8992266,15z/data=!4m2!3m1!1s0x89ace4| |

| | |7172913119:0x6662bbe60a04f883 | |

|STRIDE |Appreciate the risk of functional decline and other hazards of |Contact John Bartle (john.bartle@) VA x 6753 |

| |hospitalization associated with immobility. | |1532-5415.2004.52354.x/pdf |

| |Understand the impact of an early hospital mobilization program and| | |

| |post-hospital discharge exercise counseling. | | |

|TLC Partners |Recognize the potential problems arising during transitions of |Contact Colleen Wojciechowski, NP by email: colleen.wojciechowski@.|

| |care, and to experience a model shown to reduce recurrent |Please travel with the Nurse Practitioner. Review CPRS information ahead |ansitionalCareofOlderAdultsHospitalizedwithHe|

| |hospitalizations |of time and be prepared to discuss the patient’s condition and potential |artFailure-1262.pdf |

| |Evaluate an older adult in their home environment |problems in transitions with the NP. | |

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