J. James Cotter

A Professional Development Program in Geriatric Interdisciplinary Teamwork: Implications for Managed Care and Quality of Care

This study investigated the effectiveness of a multiyear geriatric interdisciplinary team training (ITT) program conducted by a geriatric education center in cooperation with three large health care systems. Approximately 40 half-day training sessions were planned and implemented by the university-community partnership. The training sessions included core content on team processes and substantive clinical material on geriatric concerns and disease states (dementia, diabetes, etc.). Statistical analyses revealed that a critical amount of training is necessary to induce positive changes in team skills and attitudes about geriatric health care teams. Results also indicated that maturity, practical experience, and some previous formal training in geriatrics or gerontology are predisposing factors contributing to the effectiveness of geriatric ITT. Because resources to implement these kinds of comprehensive training programs are often limited, more focused educational interventions are advisable.

Transitions of care: the next major quality improvement challenge

This review and discussion outline domains and a research agenda leading to improvements in the quality of transitions of care between health‐care settings. Over the past two decades changes in health care financing have restructured the organization and delivery of health care. Health‐care plans and insurers have shifted to provision of health care in less expensive settings and growing concerns about the quality of health care have arisen – continuity may be lost, errors may occur, and patients may end up deeply dissatisfied. To improve the quality across the continuum of care, providers will need to reconceptualize from an intra‐organizational to an inter‐organizational viewpoint and will have to focus on transitions of care across settings. Services, such as case management, must effectively bridge gaps in the continuity of care. Improved measurement of outcomes, such as satisfaction with the transition, will be necessary.

Social Workers' Use of the Internet and E-Mail to Help Clients in Virginia

A survey of a random sample of licensed social workers in Virginia showed 98.8% had Internet access in either their home or workplace. A comparison of this study with a study conducted in the early 2000s indicated more than 20% difference regarding e-mail communication with clients and Internet use for work-related research. Social workers who actually used the Internet and e-mail tended to expect a future increase in their use, in contrast with nonusers. Stepwise multiple logistic regression analyses found age and type of agency (private/for-profit) as factors negatively related to having Internet access in the workplace, age, and the reason “E-mail is not secure enough” as factors negatively related in the future e-mail communication with clients among current nonusers.

Designing a Multi-Disciplinary Geriatrics Health Professional Mentoring Program.

This paper describes a Geriatric Health Professionals Mentoring Program designed to address recruitment and retention of health professionals in geriatrics and gerontology. The training provided information on the mentoring process, negotiating mentoring agreements, and coaching mentees. The evaluative framework described examines: (a) the effects of mentoring, (b) reactions of mentors and mentees, and (c) the effect of intervening variables. Trained mentors expressed satisfaction with the program and were comfortable about general mentoring but less confident about specific guidance for mentees. A cadre of mentors can be successfully trained to assist geriatric health professionals to better care for older Americans.

Partners II—Serving Older Persons with Developmental Disabilities: Obstacles and Inducements to Collaboration Among Agencies

Neither the aging nor the disabilities services system is prepared for the rapid growth in the numbers of persons who are older and who have a developmental disability. The Partners II Project in Virginia worked simultaneously to enhance service coordination and capacity building at the local level, while providing policy direction to address barriers to efficient service provision at the state level. A survey of the several state and local service provider organizations identified operational structures and procedures that impede or facilitate service delivery. Methods used to identify potential clients, to establish client needs, to appropriate human and material resources, and to evaluate achievement of service objectives were investigated. Policy recommendations to improve service coordination were based on the results of these surveys. Service practices do not yet routinely include proactive initiatives for adults who enter later life with lifelong disabilities. The study outlines a policy-making process that is based on quantified procedures, logically derived from direct observations, and tied to pragmatic need.

Learner-Centered Online Courses/Programs in Gerontology and Geriatrics: New Responses to Changing Needs of Health Professionals

ABSTRACT This article describes recent trends that have led to an emphasis on a learner-centered approach to gerontology and geriatrics education especially in distance-based education. A learner-centered approach to education has combined with technological advances to stimulate distance-enhanced education for students in geriatric and gerontology programs. The technological advances, especially the Internet, that have enhanced the capacity of educational programs to involve students in the learning process even though separated from the instructor by time and distance, are discussed. In response to the needs of health care professionals who were seeking to enhance their skills in research, education, and leadership in their respective professions, including gerontology, the learner-centered Doctoral Program in Health-Related Sciences (DPHRS) was established in the School of Allied Health Professions of Virginia Commonwealth University. The specifics of this distance-enhanced, learner-centered program are described. The article ends with strategies for encouraging a learner-centered experience with special focus on distance-based education.

Assessing Medicaid recipient access and satisfaction. Fee-for-service, case management, and capitation.

Medicaid increasingly requires enrollment in managed care programs. This study assessed access to care, satisfaction with care, and appointment wait times during the transition from fee for service to managed care using three annual Medicaid recipient surveys. There was little evidence of dissatisfaction or poorer access among managed care recipients. Fee-for-service recipients, compared to primary care case management, reported greater general (91 vs. 78%, p < .01) and specialty care access (92 vs. 80%, p < .01). When appointments were required, adult HMO enrollees, compared to case management, had longer waits for routine care in the second (5.8 ± 8.2 days vs. 4.0 ± 6.6) and third surveys(5.5 ± 6.9 days vs. 3.8 ± 7.3); waits for other appointments did not consistently differ by program. There were no significant program differences in overall satisfaction. Findings are tempered by the potential for response bias and geographic confounding. Continued monitoring is crucial to assure that access and satisfaction remain high in Medicaid managed care.

Effect of Different Types of Medicaid Managed Care on Childhood Immunization Rates

Medicaid managed care can improve access to prevention services, such as immunization, for low-income children. The authors studied immunization rates for 7,356 children on Medicaid in three managed care programs: primary care case management (PCCM; n = 4,605), a voluntary HMO program (n = 851), and a mandatory HMO program (n = 1,900). Immunization rates (3:3:1 series) in PCCM (78%) exceeded rates in the voluntary HMO program (71%), which in turn exceeded those in the mandatory HMO program (67%). Adjusting for race, urban residence, and gender, compared to children in PCCM, children in the voluntary HMO program were less likely to complete the 3:3:1 series (OR = 0.75, CI = 0.63, 0.90), and children in the mandatory HMO program were even less likely to complete the series (OR = 0.59, CI = 0.51, 0.68). Results differed by individual HMOs. Monitoring of outcomes for all types of managed care by Medicaid agencies is imperative to assure better disease prevention for low-income children.

Oral History: A Pragmatic Approach to Improving Life Satisfaction of Elders

This study evaluated the impact of oral history interviews on life satisfaction of older adults who were interviewed by college students enrolled in a gerontology course. Using an experimental, pretest–posttest design, baseline life satisfaction scores of elders in the intervention group were compared to those in the control group immediately following three one-hour oral history interviews (posttest) and again 10 weeks later (retest). At posttest, no differences in life satisfaction were found between groups, but differences approached statistical significance at the 10-week retest indicating that, over time, oral history interviews may contribute to improved quality of life among elders.

Special care for persons with Alzheimer's disease and related dementias in Virginia adult care residences

Designing supportive care for persons with Alzheimers disease and related dementias in residential care is one of the most challenging issues facing researchers, policymakers, and facility administrators. To gain a better knowledge of the types of special care offered by adult care residences (ACRs) and assisted living facilities, the results of a survey of all licensed ACRs in the state of Virginia are presented. Examined are the facilities with special care units (SCUs) and special programs (SPs), the organizational characteristics of facilities that offer special care, the characteristics of existing SCUs and SPs, and the opinions of owners/ operators on the elements needed for establishing these units and programs. The discussion focuses on improvements needed within special care and the implications of the views of owners/ operators about special care.