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SAGE: A Unique Partnership

SAGE: A Unique Partnership . Between Reynolds GET-IT Program & Meals on Wheels, Inc. of Tarrant County Built on existing relationship Meets needs of partnering organization.

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SAGE: A Unique Partnership

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  1. SAGE: A Unique Partnership • Between Reynolds GET-IT Program & Meals on Wheels, Inc. of Tarrant County • Built on existing relationship • Meets needs of partnering organization

  2. The SAGE Program The SAGE Program was modeled after the University of South Carolina School of Medicine/Palmetto Health Senior Mentor Program, led by Paul Eleazar, MD. The SAGE Program has been modified and continually evolves to meet the needs of UNT Health Science Center’s students. The SAGE Program offers the unique opportunity for community seniors to receive in home visits with medical school and physician assistant students. Students get to see senior patients as people and not only as diseases, observe challenges faced by elderly and how medical conditions impact quality of life & the seniors’ coping mechanisms.

  3. The SAGE Program The SAGE program pairs two 1st or 2nd year medical school or physician assistant students with a senior mentor/client that receives either home delivered meals through the Meals on Wheels Program Inc. of Tarrant County or a senior in the community. • Utilizes the blackboard system to post assignments and discussion about each visit • 25 PODs with 10-22 students in each POD. PODs get to read each others assignments to see what others are learning from their seniors. • 16 SAGE Faculty Mentors that review, grade and provide constructive feedback to students in their POD.

  4. 8 Visits over 2 Years…. Students are given the opportunity to practice basic clinical skills & interviewing. Seniors receive blood pressure checks, a limited physical exam, a nutritional assessment, a home safety assessment, community resources, advanced care planning, and companionship

  5. Geriatric Minimum Competencies SAGE assignments are integrated with the recommended minimum geriatric competencies for medical students from the: AGS American Geriatrics SocietyAreas of Basic Competency for the Care of Older Patients for Medical & Osteopathic Schools AAMC Association of American Medical Colleges Geriatric Competencies for Medical Students AACOM American Association of Colleges of Osteopathic Medicine Geriatrics Curricula for Undergraduate Medical Education in Osteopathic Medicine AOA American Osteopathic Association Fundamental Osteopathic Medical Competencies

  6. SAGE CurriculumSession 1: Introduction to Senior Mentor/Client & Life Reminiscence Students learn to understand the benefits of life review, patient-centered interviewing, and assessing psychosocial issues, spiritual beliefs, and health perceptions in older adults. Elements of Recommended Minimum Geriatric Competencies Addressed: Attitude Competencies GERI-A-1 Awareness of Myths & Stereotypes GERI-A-2 Recognition of Negative Aspects of Ageism on Optimal Care of the Elderly GERI-A-3 Recognition of the Heterogeneity of Older Persons GERI-A-4 Openness & Willingness to Work With Other Disciplines in Caring for Older Patients GERI-A-5 Aging Self-Awareness & Personal Attitudes GERI-A-6 Attitude of Compassion & Understanding for Care Givers of the Frail Elderly GERI-A-7 Appreciation for Improving & Optimizing Functionality for Older People AOA Competencies: Interpersonal and Communication Skills Professionalism

  7. Session 2: Home Environment/Safety Assessment Students learn to prevent conditions that could result in falls or other injuries and to perform a comprehensive fall risk assessment for an older adult. Elements of Recommended Minimum Geriatric Competencies Addressed: Knowledge Competencies (Clinical Practice, Psychosocial Issues & Geriatric Assessment) GERI-K-11 Home Safety GERI-K-12 Falls GERI-K-13 Immobility & Gait Disturbances Skills Competencies GERI-S-2 Mobility Assessment AOA Competencies: Osteopathic Philosophy Patient Care Interpersonal and Communication Skills

  8. Session 3: Medication/ Pharmacology Students perform a medication review and learn to appreciate issues associated with prescriptions and multiple medications. Elements of Recommended Minimum Geriatric Competencies Addressed: Knowledge Competencies (Pharmacologic Changes Related to Aging) GERI-K-2 Identify Drugs to be Avoided & Explain Potential Problems with Each GERI-K-3 Inappropriate Prescribing of Meds Skills Competencies GERI-S-3 Document Patients’ Medication List AOA Competencies Medical Knowledge Patient Care Interpersonal and Communication Skills

  9. Session 4: Medical History & Physiology of Aging Students obtain a medical history and practice communication skills with special emphasis on physical changes of aging including questions about sexuality. Elements of Recommended Minimum Geriatric Competencies Addressed: Attitude Competencies GERI-A-1 Awareness of Myths & Stereotypes GERI-A-2 Recognition of Negative Aspects of Ageism on Optimal Care GERI-A-3 Recognition of the Heterogeneity Knowledge Competencies GERI-K-17 Physiology of Aging GERI-K-30 Anatomic & Histologic Changes of Aging GERI-K-29 Normal Aging GERI-K-31 Pathology of Normal Aging GERI-K-53 Sexuality & Aging AOA Competencies Medical Knowledge Patient Care Interpersonal and Communication Skills

  10. Visit/Session 5: Limited Physical Examination Students perform a limited physical and cognitive examination on an older adult, including an osteopathic structural exam. Students learn to adapt an examination to possible health conditions. Elements of Recommended Minimum Geriatric Competencies Addressed: Skills Competencies (Geriatric Assessments) GERI-S-2 Mobility Assessment GERI-S-8 Social Functioning Assessment GERI-S-4 Emotional Assessment GERI-S-9 Assessment of ADL’s GERI-S-7 Cognitive Assessment GERI-S-9.1 Assessment of IADL’s AOA Competencies Osteopathic Philosophy and Osteopathic Manipulative Medicine Medical Knowledge Patient Care Interpersonal and Communication Skills Professionalism

  11. Visit/Session 6: Community Resources & Functional Assessment Students identify current use of community resources, potential services, identify specific goals for the resources neededand complete a functional assessment. Elements of Recommended Minimum Geriatric Competencies Addressed: Attitude Competencies GERI-A-4 Openness & Willingness to Work w/ other Disciplines Knowledge Competencies GERI-K-56 Community Resources Skills Competencies GERI-S-10 Development of Management Plan AOA Competencies Systems-Based Practice

  12. Visit/Session 7: Nutritional Assessment Students perform a nutritional assessment an provide education on nutritional balance and diet modifications related to selected health conditions. Elements of Recommended Minimum Geriatric Competencies Addressed: Knowledge Competencies GERI-K-58 Primary Prevention GERI-K59 Secondary Prevention Skills Competencies GERI-S-9 Assessment of ADL’s GERI-S-10 Development of Management Plan AOA Competencies Medical Knowledge Patient Care Interpersonal and Communication Skills

  13. Visit/Session 8: Advance Care Planning & Ending the Doctor/Patient Relationship Students explore issues associated with advanced care planning (Power of Attorney, Living Will, etc.) and learn the legal and ethical processes that take place with these decisions; and identify the process for terminating the physician/patient relationship. Elements of Recommended Minimum Geriatric Competencies Addressed: Knowledge Competencies GERI-K-14.2 Advance Directives GERI-K-19 Palliative Care Based on ID of Patient’s Goals for Care GERI-K-65 End-of-Life Care AOA Competencies Patient Care Interpersonal and Communication Skills Professionalism

  14. In the Beginning The SAGE program was started in the fall of 2009 with176 medical students and 136 seniors. Year 2 2010 – • 390 Students & 169 seniors recruited Year 3 2011- • 454 DO students & 69 PA students • 141 Seniors Recruited

  15. 3rd Year Currently, in its third year with 523 students and over 280 community seniors. 454 DO Students 69 PA Students

  16. Evaluations • 8 faculty graded assignments • Cannot pass Clinical Medicine course w/o passing SAGE • Yearly evaluation on students by their senior mentor

  17. Evaluation of Student by Senior Client

  18. Senior Clients’ Evaluation Comments of Students Primary Strengths Suggestions for Improvement Plan ahead of time which student would do what Be a little more assertive Time & practice is all they need Relax and have a less hurried approach If your going to be late call • Excellent demeanor & bedside manner • Good listener • Professional • Care about me as an individual • Always listened and never tried to hurry me • Genuine Concern

  19. Student Comments • I have learned a whole lot from him, not just about medicine, but about life. • This session showed that often times elderly patients are still very healthy, sharp, and active, and that age does not have to come with a decline in health, although there will be some inevitable changes. • Hands-on experience with patients is something that I could use more of and after this SAGE visit I feel more confident about meeting new patients & about taking their vital signs. • Not all older people are as unhappy as the stereotype. This was a useful session for both the client and myself. • This is a great experience for any prospective physician.

  20. DATA

  21. Recruitment Sites

  22. Meals on Wheels, Inc of Tarrant Co. • Served more than 14,881,997 meals in Tarrant County over the past 38 years. • Volunteer force of 3,500 delivers meals to 4,000 people each year. • Professional case manager who assesses the client's needs, coordinates services, and advocates for the client with other agencies..

  23. Meals on Wheels Relationship • Built on previous relationship w/ Project Investigator • PI was on Board of Directors • Meets the Needs of Partnering Agency • Companionship for senior • Safety Check • Education

  24. Partnership • Agreement to recruit in place • Orientation breakfast for social workers at MOW • Overview of the SAGE program • Review of paperwork • Discussion of recruitment of seniors • Originally, only limitation was geographic area

  25. Senior Recruitment Challenges Screening process in place 2nd year • 40% of MOW seniors with some level of dementia • Eliminate those with high level of cognitive disabilities Geographic area expanded Increase in student enrollment – increase in seniors

  26. Maintaining the Relationship • Participate in monthly MOW social worker staff meetings • Provide breakfast to all 12 social workers at their meetings • In continuous contact w/ MOW concerning seniors welfare • We provide another set of eyes between social worker visits • Ongoing support of seniors through: • Phone calls & Emails • Updating contact information

  27. Side Effects of Partnerships • APS Investigations • Welfare Checks • Community Resources • Church involvement • Exterminator Services • Cleaning

  28. Senior Client Retention • Ongoing communication • Letters from Coordinator • Phone calls & monthly newsletters • Health Education material in folder • SAGE Card w/ BP readings • Medication Review Log • Yearly certificates of participation • End of year 2 pictures with seniors

  29. Senior Client Loss • Deaths • Dementia • Relocation • Nursing Homes • Hospice • Assisted Living • Decline in Health • Unknown June 2011

  30. What We’ve Learned in Recruiting • First look at established relationship • Look for senior sites • (Patient Care Clinic at UNTHSC, silver sneakers programs, Independent living facility, senior centers) • Establish & build a relationship • Attend Meetings • Talk to stakeholders & key people • Attend organized events • Health fairs, classes, churches

  31. Recruiting • Assess the needs (companionship, opportunity to give back, blood pressure checks, safety check) • Develop common goal • Talk & recruit seniors • Provide continuous feedback • Check progress of recruitment goal • Maintain & expand if necessary Oldest SAGE Senior 103!!

  32. UNTHSC Reynolds GET-IT Program • Janice Knebl, DO, MBA, FACP, FACOI, PI • David Farmer, PhD Program Director • Yolanda Pitts, MEd Educational Coordinator • Freddy Cantu, Administrative Coordinator

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