ACE Tracker and e-Geriatrician new models of care

1. 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

2. ACE Tracker • Acute Care for Elders (ACE) unit was developed in 1995. • A ten bed, ACE unit opened at Aurora Sinai Medical Center in 2000. • Unable to disseminate the ACE unit model broadly. • Electronic health record was common to all hospitalized seniors. • Developed software to provide a real-time report to review each patient’s plan of care. • This computer-generated checklist is available at all med-surg units of all Aurora hospitals.

3. e-Geriatrician • No geriatrician available in many 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 sites. • Geriatricians join interdisciplinary teams for scheduled teleconferences. • Team recommendations are provided to medical staff at remote sites. Aspirus Health Care Aurora Health Care geriatricians

4. 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). • Avoided an estimated 150 episodes of UTI and 7 sepsis per year. • Avoided functional decline in an estimated 830 seniors per year. • Avoided new SNF placement of an estimated 400 seniors per year. Physical Therapy Social Services The blue arrow notes the process outcomes for the original ACE randomized trials.

5. There is no mechanism to automatically tell the health care worker what to do if there is a vulnerability. There is no baseline functional status, prior to the hospital admission. We need a tool that can be used to track the patient’s functional status across the sites of care. We need to develop further collaboration among multiple health systems. Incorporate a mechanism to automatically guide the health care worker what to do. Track the patient’s functional trajectory across the sites of care. Assess the feasibility and the effectiveness of methods to identify seniors at risk , as they move from one site to another. Develop a standardized ACE Tracker software across a network of three health care systems (21 hospitals) in Wisconsin. Challenges and Next Steps: