Comprehensive Geriatric Care of Elderly Native Americans

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Comprehensive Geriatric Care of Elderly Native
Americans

• Miriam E. Schwartz
• Department of Family Medicine
• Gallup Indian Medical Center (GIMC)
• Gallup, New Mexico 87301

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Indian Health Service (IHS)

• United States Department of Health and Human
  Services
• The main federal health program for American
  Indians and Alaska Natives
• Provides health services to about 1.8 million
  Native Americans who belong to approximately 557
  federally recognized tribes in 35 states

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The Navajo Nation
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The Navajo Nation
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The Navajo Nation

• Window Rock, Arizona The Capital

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Gallup Indian Medical Center

• Located in Gallup, New Mexico about
• 5 miles from the Navajo Nation border
• Hospital with 99 beds
• Clinical Specialties include Family Medicine,
  Internal Medicine, Pediatrics, General Surgery,
  Orthopedics, ENT, Radiology, Pathology, Emergency
  Medicine, Psychiatry, Dental, OB/GYN

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Gallup Indian Medical Center

• Serves mostly the Navajo Tribe

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Gallup Indian Medical Center

• The workload at Gallup is one of the largest in
  the Indian Health Service
• Enrolled number of patients
• 43,000 individuals
• Annually - 250,000 outpatient encounters and
  5,800 inpatient admissions
• The largest staff of all Navajo Area IHS
  facilities

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Nature of Problem

• Prior to November 2007 - there was no organized
  geriatric care for the elderly patients at GIMC,
  but the need is great because our elderly
  population have unique characteristics given
  their cultural beliefs, traditions, and
  environmental situations.

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Mission and Vision of GIMC

• Mission
• We will provide health services with
• Compassion
• Accessibility
• Respect
• Excellence

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Mission and Vision of GIMC

• Vision
• We value our patients and the community.
• We will work to see that they value us.
• We will generate the revenue to maximize
  services.
• We will use resources judiciously.
• We will support patient and family involvement,
  education, and decision making.
• We will have consistency between our plans and
  our actions.

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Results of Environmental Scan

• Paucity of data about care of elderly Native
  Americans
• Comprehensive Geriatric Assessment (CGA) and
  screening tools need to be modified to fit the
  culture and traditions of the target patient
  population

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Approach to the Problem

• Geriatric Interdisciplinary Programs
• Comprehensive Geriatric Assessment
• Fall Risk Reduction Clinic
• Fall Injury Prevention Program
• Case Management of High Risk Patients
• Caregiver Support
• Financial Sustainability

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Target Population

• How will you identify?
• Patients are referred by Primary Care Physicians,
  Emergency Department Physicians, Urgent Care
  Clinic Physicians, and other Health Care
  Professionals.
• Any unique attributes or cultural concerns?
• Native American culture
• Navajo Tribe (majority of patients)
• Hopi
• Zuni
• Acoma
• Traditional Medicine

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Process and Outcome Measures

• Process
• Comprehensive Geriatric Assessment
• Fall Risk Evaluation
• Outcome Measures
• Next Slide
• Collection of Data
• Data Collector

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Process and Outcome Measures

• Outcome Measures
• Nursing Home Admissions
• Morbidity Rate
• Mortality Rate
• Health Benefits
• Functional Status
• Caregiver Burden
• Financial Sustainability

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Project Timeline

• December 2008
• Data available for the following
• Morbidity Rate
• Nursing Home Admissions
• Functional Status
• Mortality Rate

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Project Timeline

• June 2009
• In addition to the previous outcome measures
• Data will be available for the following
• Health Benefits
• Caregiver Burden
• Financial Sustainability

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Implementing the Program

• The geriatric interdisciplinary program at GIMC
  is already at its nascent state.
• Interdisciplinary team members dental
  assistants, dietitians, nurses (case manager,
  podiatry surgical), physical therapist,
  optometrist, physician assistant,
• and social workers.
• There are no new opportunities onto which the
  program was attached. We started the program.

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Implementing the Program

• Who are the key stakeholders?
• Department of Family Medicine
• Urgent Care Clinic
• Emergency Department
• Other Departments
• How do you plan to engage them?
• Meetings with chiefs of departments initially
• and asking for their suggestions
• Implementation of these suggestions

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Perceived Facilitators/Barriers

• Facilitators
• Geriatric Interdisciplinary Team Members
• Department of Family Medicine
• Other Departments

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Perceived Facilitators/Barriers

• Barriers
• Integration of this new service line into the
  business structure of the institution
• Negotiation of service agreements with other
  departments
• Development of measures that show improvement in
  geriatric care and outcomes that are sustainable
  in a constrained fiscal environment
• Local politics and bureaucracy in the institution
• Some cultural aspects of care

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Preliminary Data
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Preliminary Data
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Preliminary Data
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Sustaining the Program

• Meticulous accounting of billing and coding for
  the geriatric clinics
• - following the financial aspects of care will
  be absolutely necessary for our program

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What I Have Learned

• Cultural sensitivity for the target population is
  important in any project.
• Local politics and bureaucracy in the institution
  are significant factors in any project.
• Engaging and motivating the key stake holders and
  participants are essential elements of any new
  project.

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References

• Indian Health Service Web Site
• www.ihs.gov
• Source of Photos
• www.ihs.gov

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Thank you for your attention!Thank you very
muchfor your support graciousness and
encouragement !!!