This study validates the Flourish Index-Revised (FI-R), a tool evaluating integrated health care models. The original Flourish Index (FI) was developed in 2018 (Faul et al., 2018) and has been ...refined to align with the FlourishCare (FC)TM Model (Model) for geriatric primary care.
The Model provides integrated biopsychosocial health care to older adults. The FI-R uses 25 quality-of-care indicators and 7 contextual community indicators. The FI-R was validated with Categorial Principal Components Analysis (CATPCA) using a sample of 949 patients 50+ who were mostly female (73%), Non-Hispanic White (70%), living in urban areas (90%), and married (29%), single (22%) or divorced (19%). The mean age was 73.46 (SD=10.86) and mean years of education was 14.30 (SD=2.14).
CATPCA showed a four-dimensional structure of biological, psychological, and two social determinants of health (SDOH) subdomains: health behaviors and community. Final selection of indicators was based on total variance accounted for >0.30, absolute values of item loadings >0.45, and not having cross loadings >0.45 on two factors. Internal consistency (Cronbach Alpha) for the determinants were: biological=0.75, psychological=0.76, SDOH: community=0.70, SDOH: Health Behaviors=0.50 and total FI-R=0.95. Sensitivity to change was shown for the total FI-R, psychological determinants, and SDOH:health behaviors but not for biological determinants.
The validation of the FI-R shows promise for its usability to evaluate integrated health care models using existing measures in electronic health systems. More work is needed to improve the incorporation of SDOH:sociodemographics into the FI-R.
Abstract
Background and Objectives
In evaluating integrated care models, traditional quality measures do not account for functional and quality of life factors, affecting older adults with multiple ...chronic conditions. The objective of this study was the development and validation of the Flourish Index (FI), an instrument to evaluate integrated care, using a determinants of health model.
Research Design and Methods
The study took place within the evaluation study of the Flourish Model (FM). The FM provides care coordination services using an integrated primary care and community-based services model. Baseline data from 70 older adults were used in the validation study. Twenty-seven quality of care indicators within six determinants of health, namely biological, psychological, individual health behaviors, health services, environmental, and social, formed part of the FI.
Results
Categorical principal components analysis showed a 5-dimensional structure with psychological determinants loading on the biological determinants of health. Internal consistency (Cronbach’s alpha) for the determinants was as follows: biological/psychological = 0.73, individual = 0.58, environmental = 0.62, health services = 0.65, social = 0.67, total score = 0.97. Sensitivity to change was shown for the total FI score (F1,22 = 8.82, p = .01) and social (F1,22 = 5.82, p = .02), with a trend toward sensitivity for individual health behaviors (F1,22 = 3.95, p = .06) and health services (F1,22 = 3.26, p = .09).
Discussion and Implications
The preliminary analysis of the FI shows promise for the usability of the index to provide insight into the fundamental challenges of aging. It brings greater clarity in caring for older adults and supports quality evaluation of integrated care coordination models.
A fragmented workforce consisting of multiple disciplines with varying levels of training and limited ability to work as a team often provides care to older adults. Interprofessional education (IPE) ...is essential for preparing practitioners for the effective teamwork required for community-based, holistic, person-centered care of the older adults. Despite numerous programs and offerings to advance education and interdisciplinary patient care, there is an unmet need for geriatric IPE, especially as it relates to community-dwelling older adults and caregivers in medically underserved areas. A core group of university faculty from multiple disciplines received funding from the Health Resources and Services Administration Geriatric Workforce Enhancement Program to collaborate with community-based providers from several Area Agencies on Aging in the creation and implementation of the Interprofessional Curriculum for the Care of Older Adults (iCCOA). This geriatric curriculum is interprofessional, comprehensive, and community-based. Learners include third-year nursing students, nurse practitioner students, third-year medical students, internal medicine and family medicine residents, master's level social work students, third-year pharmacy students, pharmacy residents, third-year dental students, dental hygiene students, community-based organization professionals, practicing community organizers, and community health navigators. This article describes the efforts, successes, and challenges experienced with this endeavor, including securing funding, ensuring equal representation of the disciplines, adding new components to already crowded curricula, building curriculum on best practices, improving faculty expertise in IPE, managing logistics, and ensuring comprehensive evaluation. The results summarize the iCCOA components, as well as the interprofessional domains, knowledge, and competencies.
Abstract
To address the challenges that unique challenges that the GWEP programs had in collecting and using MIPS data to show meaningful and quality work with older adult patients, we created a ...collaboration between NAGEC and the GWEP MIPS workgroup. Our primary goal was to develop a collective understanding of how GWEPs perceived MIPS as main outcomes. To better understand the collective challenges, a survey was created to examine the diversity in the sites across all GWEPs where MIPS data was collected and to quantify the types of challenges that GWEPs faced in collecting this type of patient data. From this survey we found the following issues were most prominent: 1.) Most GWEPs had primary care sites that had a difficult time pulling date from their electronic health records; 2.) Providers at participating primary care sites struggled to enter MIPS datapoints into the EHRs; 3.) Some of the participating primary sites did not collect MIPS data; 4.) Some of the participating primary care sites do not have the time to provide us with MIPS data in a timely fashion; and 5.) Some of our participating primary care sites are different than the traditional primary care sites (eg. skilled nursing facility, hospice, emergency departments), making MIPS measures irrelevant. From this survey, we were able to develop a solution focused statement to present to HRSA and to start the conversation about the difficulties and challenges in collecting MIPS data.
Objective: Data from the Health and Retirement Study were used to test a conceptual model integrating stress and coping, conservation of resources, and life-course theories, to investigate predictors ...of depression symptoms over 8 years among a nationally representative sample of older adults aged 50-91 years. The main investigative questions were: (1) Do older adults with cancer have a different 8-year symptomatic depression trajectory than those without cancer? (2) Do the differences in life-course factors, internal, external, and health-related resources within and between older adults have a differential effect on 8-year symptomatic depression trajectories for individuals with and without a cancer diagnosis? Methods: We used a two-level longitudinal panel design to test a multilevel growth model. We examined individual differences in depression symptoms between 2000 and 2008, and tested multiple potential predictors. All those with a first diagnosis of cancer in 1998-2000 were included in the study (n = 200) together with a representative subsample of all noncancer cases (n = 1,190). Results: Significant two-way interaction effects were detected between having cancer and the absence of spouse/partner in the home, and cancer and lower life expectancy; each resulted in higher probabilities of depression. A significant three-way interaction effect was detected between cancer, gender, and social support; women with a cancer history and low social support had the highest probability of depression. Conclusion: Assessment and intervention in the "survivorship" phase of cancer should target older adults with higher levels of depression early in the cancer experience, those with no partner present in home, those with lower life expectancy, and women with low social support.
Gender differences persist in the social work academy. We follow up and extend the work of Sakamoto, Anastas, McPhail, and Colarossi. A multistage probability sample of Council on Social Work ...Education (CSWE)-accredited programs yielded a 21% response rate (n = 535) by faculty to an electronic survey. A significant difference was found on base salary with men earning $76,337 and women earning $70,400. On many status variables, women and men have achieved parity; but, men are significantly more likely to be full professors. Gender differences were found on all seven climate subscales. CSWE must obtain robust data, at the individual level, on salary and other implicit curricular items.
ABSTRACT—Treatment with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) decreases cardiovascular event rates in hypercholesterolemic patients. Whether statins exert effects ...within 24 hours on the coronary vasculature in patients with endothelial dysfunction has not been elucidated. Twenty-seven patients with stable angina pectoris and average low-density lipoprotein cholesterol concentrations of 138±9 mg/dL at baseline were allocated to treatment with placebo (14 patients) or 40 mg/d pravastatin (13 patients) in a randomized, double-blind, prospective trial. Coronary endothelial function was assessed before and 24 hours after single treatment by quantitative coronary angiography during intracoronary infusion of nitroglycerin or increasing concentrations of acetylcholine (0.01, 0.1, and 1 μmol/L). Coronary blood flow reserve was measured by Doppler velocimetry during adenosine infusion. Intracoronary acetylcholine infusion induced abnormal vasoconstriction in both groups before treatment, indicating coronary endothelial dysfunction. Treatment with a single oral 40-mg dose of pravastatin significantly attenuated acetylcholine-mediated vasoconstriction after 24 hours (mean±SE decrease in luminal diameter before and after treatment0.01 μmol/L, 6.1±2.2% versus 3.0±1.2%; 0.1 μmol/L, 15.6±2.6% versus 7.4±1.8%; P <0.05; 1 μmol/L, 22.9±2.9% versus 13.2±2.6%; P <0.05). There was no significant difference in the response to acetylcholine in the placebo group (8.1±2.4% versus 9.7±2.4%, 16.1±2.9% versus 16.8±3.2%, and 21.4±3.9% versus 23.3±4.2%). The response to nitroglycerin infusion was not altered in both groups. Increase in coronary blood flow in response to adenosine and coronary flow reserve remained unchanged during placebo and statin treatment. Serum concentrations of blood lipids and high-sensitive C-reactive protein were not significantly altered after 24 hours in response to placebo or pravastatin therapy. Statin treatment improves endothelium-dependent coronary vasomotion within 24 hours in the absence of significant cholesterol reduction. The full text of this article is available online at http://www.circresaha.org.
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