Richmond Health Research Articles

REPORTING MERIT-BASED INCENTIVE PAYMENT SYSTEM LIKE DATA IN A UNIQUE AGE-FRIENDLY HEALTH CARE SETTING

Abstract The Richmond Health and Wellness Program (RHWP) offers screening, education, care coordination, and resources as an enhancement to primary care for older adults in five low-income apartment buildings and in a community center. Participants may receive primary care through multiple healthcare systems in the region that do not have a common electronic medical record (EMR). To track age-friendly workflows to the Health Resources Services Administration (HRSA) in the domains of advance care planning, falls prevention, and high-risk medication use, case note documentation in a REDCap database is used to generate Merit-based Incentive Payment System (MIPS)-like data. We report on advance care plans developed, fall risk screenings and risk reduction interventions implemented, high-risk medications screened, and referrals to primary care for high-risk medication deprescribing, including risk reduction with opioid use. When reporting MIPS data to HRSA, we include a disclaimer for RHWP data defining the numerator and denominator used for the MIPS-like measure calculation. For example, when reporting advance care plan completion, we include “RHWP is a care coordination site and care is not provided at the site. The population includes adults aged 55+ or people (of any age) with disabilities in low-income congregate living facilities and all adults participating in RHWP at the Virginia Commonwealth University Health Hub.” The numerator indicates the number of clients with advanced care plans created, and the denominator indicates the total number of clients seen during the reporting period. This presentation will provide strategies to meet reporting requirements when EMR records are not available.

Socioeconomic Effects on Psychosocial Factors Among Low-Income Older Adults.

Objectives: Older adults have been disproportionately affected by COVID-19. The primary goal of this study is to determine the socioeconomic effects on psychosocial factors among low-income independent-living older adults, in an urban setting, during the COVID-pandemic. Methods: Participants were recruited through Virginia Commonwealth University’s Richmond Health and Wellness Program. Telephone surveys (n=100) were conducted using the Epidemic – Pandemic Impacts Inventory Geriatric with the Racial/Ethnic Discrimination addendum. Responses were analyzed for income and education effects across seven domains: home life, social activities/isolation, economic, emotional health-wellbeing, physical health, COVID-infection history, and positive change behaviors/experiences. Results: The sample population was between 51 and 87 years of age, 88% were Black, 57% reported incomes of $10,000/year or less, and 60% reported a high-school education or less. There were income effects for social activities/isolation (f = 3.69, p<.05) and positive change (f = 8.40, p<.01), and education effects for COVID History (f = 4.20, p <.04). Discussion: Overall results highlight the social patterns for a diverse sample of low-income urban older adults; education and income are identified as risk factors for social losses, COVID-infection experiences, racial/ethnic discrimination during the COVID-pandemic, and positive change behaviors.

Evaluation of students' knowledge, values, and experiences in a geriatrics interprofessional practice-based model

Background and purposeThe objective was to evaluate (1) students' knowledge in a variety of geriatrics competencies, (2) students' attitudes toward the value of interprofessional practice, and (3) pharmacy students' experiences after an advanced pharmacy practice experience (APPE) in a practice-based interprofessional education (IPE) model. Educational activity and settingNursing, pharmacy, social work, and health sciences programs who participated in the Richmond Health and Wellness Program (RHWP) interprofessional experience received pre- and post-surveys to assess changes in geriatrics knowledge. An adapted Attitude Toward Health Care Teams Scale (ATHCTS) was used to assess changes in students' attitudes toward the value of interprofessional teamwork. Finally, representative quotes were taken from APPE evaluations to illustrate the pharmacy student experience. FindingsSeventy-two out of 82 (87.8%) interprofessional students who participated in the practice-based IPE model at RHWP in the fall 2018 participated in this study. Geriatrics knowledge scores significantly increased by 4.03 (P < .001) with a significant change in some knowledge domains: frailty (P = .005) and medication knowledge (P = .017). Attitudes toward the value of interprofessional practice increased with a statistically significant difference in the ATHCTS quality of care subscale (P < .001). Pharmacy students found the interprofessional collaboration to be valuable. SummaryA practice-based IPE experience can provide many benefits to health professional students. By working as a team, students learn from each other, leading to increased knowledge on several geriatrics competencies. Students understand the importance of IPE experiences, but their attitudes become more positive through application.

Partnerships Connecting Healthcare and Community-Based Organizations in Virginia

The Virginia Geriatric Education Center (VGEC)’s Geriatrics Workforce Enhancement Program (GWEP) partners with two programs, Senior Strong at Eastern Virginia Medical School in Norfolk, VA and the Richmond Health and Wellness Program at Virginia Commonwealth University in Richmond VA to support their age-friendly initiatives. These programs enhance primary care for an older population experiencing adverse social determinants of health by providing screening around the 4Ms pillars of age-friendly healthcare and connecting participants with healthcare and community-based organizations. These programs offer a rich learning environment for interprofessional students. The VGEC GWEP strengthens these programs by developing faculty and student training in collaboration with the programs and facilitating program participation in the GWEP-CC Age-Friendly Action Community to develop and refine age-friendly practice workflows, referral pathways and documentation.

Geriatric Opioid Harm Reduction: Interprofessional Student Learning Outcomes.

Objective: Opioid harm reduction is increasingly important in the care of the older adults, who are at higher risk for negative opioid-related outcomes due to high prevalence of pain, multimorbidity, polypharmacy, and age-changes in metabolism. Our project aims to develop, implement, and evaluate an interprofessional opioid harm reduction service training. Method: This evaluation occurs in context of the Richmond Health and Wellness Program (RHWP), a community-based interprofessional wellness care coordination equity initiative, within buildings designated for low-income and disabled older adults. The geriatric opioid harm reduction training was delivered online and inperson, and followed up with case-discussions and practice. Findings: Pre (n = 69)/post (n = 62) student assessments indicated that after the training, there was an increase in knowledge. At follow-up, 60% recognized tramadol as an opioid, 50% at baseline. About 97% correctly indicated that MME represents morphine milligram equivalent, 80% at baseline. About 93% indicated that 50 MME level greatly increases opioid overdose risk, 62% at baseline. Only 20%, change from 60% at baseline, reported not being able to calculate MME at post assessment. Conclusion: Findings indicate that geriatric opioid harm reduction training within community-based wellness care coordination is feasible. Future works need to explore the impact on student practice in clinical settings and resident health.

REDUCING OPIOID OVERDOSE RISK IN A COMMUNITY CARE COORDINATION CLINIC: RICHMOND HEALTH AND WELLNESS PROGRAM

Objective Opioid safety is increasingly important in the care of older adults due to higher risk for negative opioid-related outcomes related to higher prevalence of chronic pain, multimorbidity, polypharmacy, and age-associated changes in drug metabolism and elimination. Evidence-based practices for screening and safe opioid use for older adults are needed. Our project aims to develop, implement, and evaluate a care-coordination workflow and interprofessional clinical opioid misuse screening, support, and referral training to support older adult care. Methods Our research occurs in context of the Richmond Health and Wellness Program (RHWP), a community-based interprofessional care coordination initiative, with interprofessional faculty and students providing on-site integrated care to residents in low-income senior housing communities. Curriculum development, and interprofessional clinical faculty, peer support, and health professions student training have been conducted. Results will discuss the findings from the health professions student training. Findings The Opioid Overdose Risk Reduction Curriculum was delivered via Blackboard and in-person during student orientation. Pre (n=66)/Post (n=59) assessment indicated that after the training, there was an increase in knowledge, specifically change from 50% at baseline, 60% recognized Tramadol as an opioid, change from 80% to 97% understanding that MME represents Morphine Milligram Equivalent, and change from 62% to 93% understanding that 50 MME level greatly increases overdose risk. Only 20%, change from 60%, reported not being able to calculate MME. Conclusions Our findings indicate that opioid safety training within community care coordination is feasible. Future works needs to explore the impact on resident health as the workflow is implemented.

Surveying for Environmental Health Justice: Community Organizing Applications of Community-Based Participatory Research

Abstract Although the benefits of community-based participatory research (CBPR) for community and university partners have been well documented, these have mostly focused on disseminating research findings. However, how CBPR can function as a useful community organizing tool remains understudied. We present the CBPR process of an environmental health survey conducted by a team of community organizers and academic researchers in Richmond, CA, to describe how survey research can be aligned with community organizing principles and methods. Through a case study of our Richmond health survey that documented and quantified neighborhood concerns and health problems, we describe and analyze three steps through which community organizing and CBPR align: community-driven hypothesis generation and testing, how community surveyors are trained and study participants are recruited, and how results are applied and disseminated to policy advocacy and community action. Our case study of surveying for environmental health ...

Our Environment, Our Health

This study presents a health survey conducted by a community-based participatory research partnership between academic researchers and community organizers to consider environmental health and environmental justice issues in four neighborhoods of Richmond, California, a low-income community of color living along the fence line of a major oil refinery and near other industrial and mobile sources of pollution. The Richmond health survey aimed to assess local concerns and perceptions of neighborhood conditions, health problems, mobile and stationary hazards, access to health care, and other issues affecting residents of Richmond. Although respondents thought their neighborhoods were good places to live, they expressed concerns about neighborhood stressors and particular sources of pollution, and identified elevated asthma rates for children and long-time Richmond residents. The Richmond health survey offers a holistic, community-centered perspective to understanding local environmental health issues, and can inform future environmental health research and organizing efforts for community-university collaboratives.

Implementation and Evaluation of a Pharmacist-managed Diabetes Service

OBJECTIVE: To evaluate the impact of a pharmacist-managed diabetes service on changes in hemoglobin A1C (HbA), blood pressure, lipids, and smoking status in diabetic patients. DESIGN: A prospective analysis of the outcomes of a pharmacist-managed diabetes referral service compared to outcomes of standard medical care provided by physicians in a matched historical control. SETTING: Richmond Health Care Group, a managed care-affiliated physicians group in Virginia. PATIENTS: 16 type 2 diabetics in the historical control group; and 26 type 2 and 6 type 1 diabetics in the intervention group with a HbA" value greater than 8%, or a documented elevated systolic (over 130 mm Hg) or diastolic (over 85mm Hg) blood pressure, or elevated low density lipoprotein (LDL) cholesterol level that was 120% of goal or more. INTERVENTIONS: Patients in the intervention group received dosage adjustments, diabetes self-management training, and periodic assessment of treatment goals by pharmacists. MAIN OUTCOME MEASURES: HbA,c, systolic blood pressure (SBP), diastolic blood pressure (DBP), LDL, and smoking cessation. RESULTS: At the end of the study the mean :l:SD HbA" was 7.5 :I: 1.2% (95% CI, 7.05-7.98%) for the intervention group and 8.5 :I: 1.4% (95% CI, 7.8and-9.20%) for the historical control group, 11=0.02. There was no statistical difference in SBP and DBP between the two groups, although there was a trend toward a lower SBP in the intervention group (mean:l: SD SBP 133.5:1: 17.9 mm Hg; 95% CI, 127.2-139.9 mm Hg) compared with the historical control group (mean :I: SD SBP 140.1 :I: 14.9 mm Hg; 95% CI, 132.8-147.4 mm Hg), 11=0.22. There was no difference between baseline (mean :I: SD LDL 123.6 :I: 39.8 mg/dL; 95% CI, 108.3-138.9 mg/dL) and follow-up LDL (mean :I: SD LDL 121.2 :I:30.6 mg/dL; 95% CI, 102.2-140.2 mg/dL) by within-group analysis, 11=0.82. CONCLUSION: A pharmacist-managed diabetes service was effective in reducing HbA" values in diabetic patients. This study demonstrates the positive impact of clinical pharmacists in achieving a primary therapeutic goal in diabetic patients for overall diabetes control and possibly blood pressure.