Profile of Chinese American Elders Enrolled in a Geriatric Program at an

NYC Community Health Center

10/1/2009 – 9/30/2011

APHA Annual Meeting

November 1, 2011

Charles B. Wang Community Health Center

Presenter Disclosures

The following personal financial relationships with commercial interests relevant to this presentation

existed during the past 12 months:

Ady Oster

No relationships to disclose

Summary Chinese-Americans are fastest-growing elderly

segment in NYC Face multiple barriers – language, poverty,

education, culture We report on our experience in caring for 230

vulnerable elders in a primary care-based geriatric practice

Center Background Charles B. Wang Community Health Center

FQHC founded in 1971 4 locations in Manhattan and Queens

40,000 patients making >200,000 visits in 2010 90% prefer language other than English

Manhattan’s Chinatown Pell Street, 2009

Manhattan’s Chinatown Population 2006: 84,800

66% Asian 59% foreign-born 70% of Asians < high school education 71% elders: limited English proficiency 31%: below poverty line

Proportion of Elders in Chinatown growing: 30% increase over 10 years

Asian American Federation of New York, 2004

Program Background Needs assessment (2006):

Chinese elders report difficulty navigating health and social service system

Increased need for health care, social services, care coordination and outreach

Medical Home for Chinese American Elders: geriatric practice serving vulnerable elderly modeled on

Patient-Centered Medical Home Two-year period Launched: October 1, 2009

Program Background Enhanced services:

Screen for vulnerability Comprehensive geriatric assessment Psychosocial assessment Individual care plans Medication management

Service goal Screen 1,000 seniors for vulnerabilities Enroll 200 for enhanced care

Funding Program Cost: total ~ 500K Fan Fox and Leslie R. Samuels Foundation contribution: 250K

Program Outline:

Negativen = 1,161

Negativen = 181

Comprehensive Geriatric Evaluationn = 214

Declined to participaten = 16

Positiven = 230

VES 13

Positiven = 411

Initial Geriatric Screenn =1,572

Demographics

Male

Female

Gendern=230

98%

1%

1%

Ethnicityn=230

Chinese

Caucasian

Other

Demographics

83%

14%

1%2%

Languagen=230

Mandarin

Cantonese

English

Other

94%

1%

1%

4%

Birth Countryn=230

China

USA

Taiwan

Other

Demographics

*Insurance status for primary or secondary insurance

Insurance*n=230

Dual (Medicare & Medicaid), 79%

Medicare only, 3%

Managed Medicare, 6%

Private, 5%

Medicaid only, 4%

Managed Medicaid, 3%

Assessments

Negative53%

Positive21%

Unknown26%

Unknown8%

Normal38%

Abnormal54%

Mini-Cog: Timed Get up and Go:

N= 214

Assessments

Scale N Mean (SD)

ADL (Activities of Daily Living; Range from 0-12)

203 10.4 (2.1)

IADL (Instrumental Activities of Daily Living; Range 0-16)

201 9.6 (3.8)

K6 (Psychological Distress Assessment; Range 0-20)

177 1.63 (3.0)

SF-8 Mental Score(Quality of Life; Range 30-70; US mean = 50)

49 55.0 (5.3)

SF-8 Physical Score(Quality of Life; Range 30-70; US mean =50)

49 42.3 (9.3)

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Services Utilized:Provider Visits

Total = 2,633Mean = 11.4SD = 5.6

Services Utilized:Social Work Visits

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Total = 1, 614 Mean = 7.0 SD = 9.1

Services Utilized:Frequency of Mental Health Visits

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Services Utilized:Frequency of ED Visits or Hospitalizations

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Limited to those with ED/Hospital visit:

N = 29

Mean = 3.8

SD = 3.1

Overall:

Total Visits = 111

Mean = 0.5

SD = 1.7

Elders with hospital visits = 7

Elders with ED visits = 22

Reasons for Hospitalization or ED Visits(n = 57)

20% 20%

13%

9%7%

5%4%

2%

98%

95%

89%

82%

73%

61%

41%

21%

0%

25%

50%

75%

100%

Trauma CV ID Neuro GI ONC Pulm GU Heme

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Incidence

Cummulative Incidence

Conclusions Chinese Elders enrolled in a primary care

geriatric program

Multiple visits with providers and social workers High rates of dementia (mild), mobility difficulty,

diminished capacity performing IADL’s Low rates reported depression/other psychiatric illnesses

Low utilization of mental health services Relatively low overall utilization of ED/Hospitals

Small group of high utilizers

Barriers: Lack of language-proficient social work

support Need for language-proficient Home Health

Aids Transportation barriers Cultural barriers accessing mental health?

Possible Future Programs:

Patient navigation

Travel companions

Social work funding For FQHC

For patients receiving care from private MD’s

We are grateful for the generous support from

the Fan Fox & Leslie R. Samuels Foundation

Thank You

Team Members Clinical Director: Ady Oster, MD, MBA Program Advisor: Susan Seto-Yee, RN, MPA Program Manager: Jaclyn Tsang Physician Champion: Ginger Wey, MD Social Worker: Amanda Wong, LMSW Social Work Assistant: KC Wong Registered Nurse: Joyce Ling, RN Care Manager: Cora Toa Health Educator: Melissa Ip, RD

Contributing managerial staff: Regina Lee, JD; Manna Chan-Espin, LCSW; Tracy Wu, RN; Ida Wong; Ina Elbaar; Shao-Chee Sim, PhD; Perry Pong, MD; Betty Cheng, LCSW

Geriatric Screening Tool

Vulnerable Elders Survey (VES-13)

Geriatric Assessment

Mini-Cog Dementia Screening

KATZ Activities of Daily Living (ADL) Scale

LAWSON Instrumental Activities of Daily Living (IADL) Scale

Medication Management Assessment

Psychosocial Assessment (page 1)

Psychosocial Assessment (page 2)

Psychosocial Assessment (page 3)

Emergency Room (ER) History

Hospitalization History