Improving Care for Older Adults with

Serious Illness

Amy S. Kelley, MD MSHSBrookdale Leadership in Aging, 2009

FellowMount Sinai School of Medicine

June 8, 2011

Aims of Brookdale Fellowship

“I aim to be a leader working to promote appropriate, preference-guided medical decision making for

older adults”

Research skills and mentored experience

National discussion regarding policy to improve care

Brookdale network

TreatmentIntensity

for Patientswith Serious

Illness

Patient Financial

Access to Care

Likelihood PatientWill Benefit From

Treatment

Family Preferences

Local Practice Patterns

Regional Supply of Medical Resources

Patient Preferences

Patient Communication of Preferences

Individual Physician Practice Patterns

Patient Characteristics

Patient & Family Determinants Region & Physician Determinants

Family Characteristics Physician Characteristics

Aim: Examine the relationship between functional status and hospital use in the last 6 months of life.

Participants: 2,493 Health and Retirement Study (HRS) decedents

Data: HRS, Medicare claims and the Dartmouth Atlas.

Outcome: Total hospital days in the last 6 months of life.

Methods: Two-part regression models Adjust for patient characteristics, regional

resources and hospital care intensity (HCI).

Patient Characteristics Hospital Days, (95% CI) Functional Status, reference group Independent   Stable, Severe (4-6 ADL) impairments 3.50 (0.41,7.26) Declined, Independent to Moderate 4.72 (2.31,7.63) Declined, Moderate to Severe 7.94 (4.97,11.91) Declined, Independent to Severe 9.13 (6.85,11.50)Race, reference group non-Hispanic white   African American 6.13 (3.58,8.83) Hispanic 5.03 (1.49,9.44)Medical Conditions   Alzheimer’s/Dementia -2.89 (-4.18,-1.45) Chronic Kidney Disease 2.57 (0.94,4.30) Congestive Heart Failure 1.91 (0.51,3.50) Diabetes 2.48 (1.07,3.90) Stroke or TIA 2.10 (0.28,4.02)Relative Live Nearby -1.62 (-2.87,-0.47)

Hospice Admission within 6 months -1.89 (-3.25,-0.70)Hospital Beds per 10,000 residents in HRR (mean+1std vs mean-1std) 1.42 (0.07,2.83)Specialists per 100,000 residents in HRR (mean+1std vs mean-1std) 2.02 (0.64,3.35)

Hospital Care Intensity Index (mean+1std vs mean-1std) 2.23 (0.62,3.87)

Characteristics Associated with Hospital Days in Last 6

Months

HRS Investigators meeting

Drs. Ken Langa and Ken Covinsky

Future efforts to improve the HRS for use in aging and palliative care research.

Evidence-based training in communication skills

Funded by the National Cancer Institute

Anthony Back, Robert Arnold, James Tulsky and Walter Baile

GERITALK Intensive Communication skills training for

Geriatrics and Palliative Medicine fellows

Pilot tested 2010-2011

Added to Fellowship Core Curriculum 2011

American Geriatrics SocietyJr Faculty Research SIG steering

committee

Vice-Chair 2010-2011

Mentoring Program 2011

90+ Mentor-Mentee matches, biggest to date!

Steering Committee Chair: 2011-2012

Liaison to AGS Research Committee

Future Directions

“I aspire to be a leader in promoting high-quality preference-guided health care to older adults with

serious illness.”

Career Development Award Independent Investigator

National role in shaping policy to improve care

Clinical work in Geriatrics and Palliative Care

Translate research to clinical / educational programs

Teaching / Mentoring

Thank You

Brookdale Foundation, Leadership in Aging Fellowship

Mentors :

Catherine Sarkisian, MD MSHS

Sean Morrison, MD

Susan Ettner, PhD

Neil Wenger, MD, MPH