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Mental Health & Older Adults:Mental Health & Older Adults:The Wisconsin Geriatric The Wisconsin Geriatric

Psychiatry Initiative (WGPI) Psychiatry Initiative (WGPI) & &

“Star” Method“Star” Method

Linda Buel RNLinda Buel RNMay 8, 2009May 8, 2009

22

OverviewOverview

The public health crisisThe public health crisis Introduction of WGPI & the Star methodIntroduction of WGPI & the Star method Early resultsEarly results Outcomes measurement plan Outcomes measurement plan ReachReach

Issues – now and in 2030

Population aged 65 and older will increase from 20 million in 1970 to 69.4 million

Older adults with mental illness will increase from 4 million in 1970 to 15 million

Ratio of Geropsychiatrists to older adults - Ratio of Geropsychiatrists to older adults - 1:11,451 to 1:20,195 1:11,451 to 1:20,195

Jeste, Alexopoulus, Bartels, et al., 1999Association of Directors of Geriatric Academic Programs' "Status of Geriatric Workforce Study"Association of Directors of Geriatric Academic Programs' "Status of Geriatric Workforce Study"

Consequences

compromised quality of life increased morbidity and mortality-

increased service visits, increased burden to medical care providers, and heightened annual costs of care.

premature nursing home placement preventable hospitalizations

Bartels Stephen J, Michael A. Smyer, Mental Disorders of Aging: An Emerging Public Health Crisis?

55

Wisconsin Geriatric Psychiatry Initiative: Wisconsin Geriatric Psychiatry Initiative: Addressing Complexity in the Face of ScarcityAddressing Complexity in the Face of Scarcity

Goal: Goal: to enhance the delivery of mental health services to to enhance the delivery of mental health services to

older adults in Wisconsinolder adults in Wisconsin Methods:Methods:

indirect care via case-based consultative teaching indirect care via case-based consultative teaching sessions, using the Star Methodsessions, using the Star Method

more widely disseminate principles of geriatric more widely disseminate principles of geriatric psychiatry to different groups of providers: psychiatry to different groups of providers:

health care: medical and psychiatric health care: medical and psychiatric long-term carelong-term care aging networkaging network

network weaving: shaping an infrastructure via the network weaving: shaping an infrastructure via the strength of weak tiesstrength of weak ties

Dr. Tim HowellDr. Tim Howell

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Determinants of HealthDeterminants of Health

(

Evans and Stoddart, 1990)

77

Understanding & Addressing Geriatric Understanding & Addressing Geriatric Problems: Problems:

The Wisconsin “Star” MethodThe Wisconsin “Star” Method

Symptom,Problem

MedicationIssues

Social Issues

Personal Issues(Personality)

PsychiatricIssues

Medical Issues

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Early Results - 1Early Results - 1

Community Health Partnership report Community Health Partnership report PatientPatient

Dates of ServiceDates of Service Date of consultationDate of consultation

Activity beforeActivity before Activity afterActivity after

Early Results - 2Early Results - 2

Community Health Partnership reportCommunity Health Partnership report Patient Issues Team Issues

Organization Issues CT Session results

Changes after consult

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OutcomesOutcomes

BEFORE & AFTER SESSIONBEFORE & AFTER SESSION

Specific to this case how would you rate (the team) Specific to this case how would you rate (the team) in the following:in the following: -2-2 -1-1 00 11 22

InsightInsight               

EnthusiasmEnthusiasm               

ClarityClarity               

MotivationMotivation               

UnderstandingUnderstanding               

Professional comfort re: how team is workingProfessional comfort re: how team is working               

Professional comfort re: this current situationProfessional comfort re: this current situation               

Level of hope about this memberLevel of hope about this member               

Level of hope about his situationLevel of hope about his situation               

1111

OutcomesOutcomes

To what extent do you agree that To what extent do you agree that the results of the Star Method the results of the Star Method affect patients':affect patients':

disagree disagree stronglystrongly

disagree disagree slightlyslightly

neither neither agree or agree or disagreedisagree

agree agree slightlyslightly

agree agree stronglystrongly

quality of lifequality of life               

self-reported health statusself-reported health status               

physical functionphysical function               

emotional functionemotional function               

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ReachReach

Milwaukee: CCO (PACE/Partnership/Family Care), Aurora Geriatrics, & ALM (CBRF)

Madison: Care Wisconsin, Family Services Eau Claire: CHP (Partnership/Family Care) AGS website: www.americangeriatrics.org San Antonio & Galveston TX (U Texas), Columbia MO

(U Missouri), Rochester MN (Mayo), Baltimore MD (Johns Hopkins), & Milwaukee (MCW): geriatric medicine fellowship programs (by speaker phone from Aurora Geriatrics)

Dr. Tim Howell

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AcknowledgementsAcknowledgements

Tim Howell, MD, MA; WGPITim Howell, MD, MA; WGPIGeriatric PsychiatristGeriatric PsychiatristAssociate Professor, UW Dept of PsychiatryAssociate Professor, UW Dept of Psychiatry

Cathy Swanson-Hayes - DHSCathy Swanson-Hayes - DHS Other members of the WGPI coalitionOther members of the WGPI coalition

University of Wisconsin Hospital & ClinicsUniversity of Wisconsin Hospital & Clinics