Eastern Colorado Geriatric Research, Education and Clinical Center (GRECC) - VA Eastern Colorado Health Care System
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VA Eastern Colorado Health Care System

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Eastern Colorado Geriatric Research, Education and Clinical Center (GRECC)

 

Clinical

20 December 2019

Eastern Colorado GRECC is a hub of clinical innovation committed to creating systems of support for Veterans as they age and across the continuum of care, regardless of geography. The Eastern Colorado GRECC participates in national clinical dissemination projects, including GRECC Connect and Gerofit.

Clinical demonstration projects provide opportunities to integrate research, education and clinical services. Current Clinical Demonstration Projects include:

 GRECC Connect
The goal of GRECC Connect is to improve access to geriatric care for Veterans in rural areas. Older Veterans living in rural areas often have limited access to geriatric care and rural providers and staff often lack opportunities to learn about best practices for management of Veterans with geriatrics syndromes.

The Eastern Colorado GRECC links geriatrics specialists (geriatricians, palliative care physicians, geropsychologist, social workers, pharmacists, audiologists and trainees), located at Rocky Mountain Regional VAMC with six outlying community-based outreach clinics (CBOCs) and Veterans in their homes.

Activities: Current modalities include clinical video telehealth, electronic consultation, and educational teleconferences. Consultation is provided in tele-geriatrics, tele-palliative care, and tele-geropsychology. All visits are transdisciplinary with at least physician, social worker, and pharmacist input. Many veterans and caregivers are also seen by the geropsychologist, especially related to dementia and caregiver support needs.

Through this project, we aim to equip rural providers and staff with the knowledge and skills to care for older adults, and to support staff at rural clinics by providing geriatrics consultation.

Accomplishments: In FY18, the GRECC Connect program served 154 veterans and resulted in 30,412 miles saved by providing tele-health visits closer to the veterans’ residence.

Visit GRECC Connect page highlighting Eastern Colorado.
 Vet Connect
Eastern Colorado became a GRECC Connect site at the conclusion of FY17. As part of GRECC Connect, we are partnering with Dr. Cari Levy and the VA Seattle-Denver COIN in the VHA Office of Rural Health funded clinical demonstration project – Vet Connect.

The goals of this program are to conduct tele-health geriatric, palliative care, and psychotherapy visits to Veterans in community nursing homes (CNH), beginning with Denver Metro facilities and expanding to rural State Veterans Homes/Community Living Centers.

Activities: Vet Connect addresses the challenges facing Veterans transitioning from VA hospitals to CNHs for sub-acute rehab after an acute illness. The program provides an easy, convenient way for Veterans, CNH staff, and VA staff to coordinate care to improve Veteran care, safety, and care coordination.

Accomplishments: In FY 18, we provided 309 televisits (223 to CNH and 86 to SVH), engaged with three SVHs and 11 CNHs, in five specialties: Geriatrics, Palliative/ Hospice care, Mental Health, Psychiatry, and Gero-psychology, and with over 9 different providers.
 Virtual Tours for Community Nursing Homes: Improve Care Coordination via Video Technology
The goal of Virtual Visits is to aid in Veterans’ transition from in-patient hospital stay to nursing facilities. Through virtual tours to nursing homes prior to discharge, Veterans and their families may ask questions, see potential future living quarters, and make educated choices regarding their future health care.

Activities: VA in-patient Social Workers identify appropriate patients and offer them the option of participating in a tour. If the Veteran or Veteran’s family is interested, the project team coordinates with the Veteran’s potential nursing homes staff (often admissions or social services) and, at the time of the visit, utilize secure Facetime or Veteran Video Connect applications to conduct the tour of the nursing home from the patient’s bedside. This is a collaboration between the GRECC, COIN and QUERI. It is funded as a COIN Shark Tank proposal internally (PI: Cari Levy) and supported by Dr. Cathy Battaglia of the QUERI.

Accomplishments for the year: In FY18, virtual tours were initiated. As of December 2018, 11 virtual tours have been conducted with 11 unique veterans.
 GeroFit
I think it’s a great way for Veterans to stay active and enjoy the camaraderie that each other’s company brings
Gerofit, first developed in 1986 at the VA Medical Center in Durham, NC, is a group-based, supervised exercise program for Veterans over 65. The Denver-based Gerofit program began July 1, 2018.

Veterans meet three times a week for two hours of exercise, which incorporates balance, core coordination and strength training. Local experts lead discussions on topics of interest during monthly Gerofit Learning Opportunities for Wellness (GLOW) classes. Themes include arthritis, adult vaccines and the effect of exercise on sleep. The Eastern Colorado GRECC Gerofit Program beat its enrollment goal as the program grew to 33 enrolled participants within the first few months and routinely receives 2-3 consults a week.

Dr. Lauren Abbate, a Rocky Mountain Regional VA Medical Center emergency department physician and GRECC Advanced Research Fellow, serves as the program director. In FY19, she will capitalize on the networks formed through the Veteran Community Partnership and other engagement efforts described in the next section to expand the Denver-based Gerofit program to rural areas of the state.
 Targeted Audiologic Training and Support
Audiology Clinical Demonstration Project trains Associated Health Trainees, Geriatric Medicine Fellows and GRECC clinical faculty on audiology best practices while supporting patient referral for hearing health screening. Tinnitus and hearing loss are the two most prevalent disabilities reported among Veterans receiving VA benefits. Hearing loss causes, contributes to, or exacerbates: communication challenges, social isolation, anger, frustration, fatigue and cognitive decline.

The director of the audiology department at the Rocky Mountain Regional VA Medical Facility and two successive cohorts of GRECC-supported audiology externs have carried out a clinical demonstration project that focuses on providing training in audiology best practices to other Associated Health trainees, Geriatric Medicine Fellows and GRECC clinical faculty.

Our needs assessment identified that health care providers receive little to no education in audiology best practices, despite the high percentage of older Veterans with significant hearing loss. The audiology supervisor and trainees address this gap through a variety of approaches described in detailed in the clinical demonstration project section of this report.
 Geriatric Scholars Physical Function Workshop and Practicum Experience
The purpose of the Geriatric Scholars Physical Function workshop is to provide intensive face-to-face training in functional assessment and intervention to rehabilitation professionals, namely Occupational Therapists and Physical Therapists, who wish to gain more expertise in geriatrics. The course is also appropriate for primary care clinicians who wish to extend their knowledge of functional disability and recovery in older populations.

The overall goal is to improve assessment, intervention, and prevention related to functional abilities in order to support older Veterans’ ability to live independently and remain in their homes. The course emphasizes more progressive intervention strategies to address the widespread tendency to provide low dose rehabilitation interventions. This course provides an overview of the research behind techniques to improve function more efficiently to ensure clinicians can carry this information over into individual treatment programs for Veterans. Course instructors help identify barriers to treatment and how to work around those obstacles. This workshop includes a one-day quality improvement course to provide intensive training in conducting quality improvement projects at local facilities.

Clinical Resources

Home-Based Primary Care

Extensive clinical video tele-health (CVT) program (geriatrics, dementia, palliative care)

Geriatric Evaluation and Management (inpatient and outpatient clinic)

Patient-aligned care teams (PACT) in geriatrics and palliative care

Palliative Care inpatient and outpatient consultation program (directed by C. Levy)

Medical Foster Home (directed by C. Levy)

Veteran Video Connect to Home (J. Sussman for patients with dementia and caregivers in rural areas)

ECHCS and InnovAge (PACE) collaboration for the care of frail older Veterans

Contract Nursing Home Program: this program pays for housing of Veterans in local nursing homes

Palliative Care/Hospice Collaboration; Adult Day-Care

Colorado Fitzsimons State Veterans Home: this facility cares for Veterans and their family members and is staffed by CU-SOM faculty

Advance Care Planning Group Medical Visits Program using The Conversation Project tool

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