Browsing by Author "Knebl, Janice"
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Item A Collaborative Implementation Strategy to Increase Falls Prevention Training Using the Age-Friendly Health Systems Approach(MDPI, 2022-05-12) Severance, Jennifer J.; Rivera, Solymar; Cho, Jinmyoung; Hartos, Jessica; Khan, Amal; Knebl, JaniceFalls in the home and in community environments are the leading cause of injuries and long-term disabilities for the aging population. The purpose of this study was to examine outcomes of a partnership among an academic institution, government agency, community organizations, and emergency management services to implement a falls prevention training program using an Age-Friendly Health Systems approach. In this prospective study, partners identified gaps in services and targeted and non-targeted delivery areas for implementation of an evidence-based falls prevention intervention addressing the 4Ms of Age-Friendly Health Systems-Mobility, Medications, Mentation, and What Matters. Descriptive statistics were calculated for program implementation and participant demographic variables, and paired t-test analysis compared scores for self-assessed general health and falls efficacy prior to and after program participation. Twenty-seven falls prevention classes were implemented, with over half (52%) in targeted areas. A total of 354 adults aged 50 and older participated, with N = 188 participants (53%) completing the program by attending at least five of eight sessions. Of completers, 35% resided in targeted areas. The results showed a statistically significant improvement in falls efficacy by program completers in targeted and non-targeted areas. However, there was no statistically significant difference in self-rated health. Overall, the findings of this study indicate that collaboration to deliver falls prevention training can be effective in reaching at-risk older adults. By mobilizing collaborative partnerships, limited resources can be allocated towards identifying at-risk older adults and improving community-based falls prevention education.Item A STEP in the Right Direction: An Interdisciplinary Transitional Care Approach to Preventing Hospital Readmissions (2015)(2015-03) Loewen, Ashlee; Knebl, Janice; Yarabinec, Ashley; Camp, Kathlene E.; Johnson, Valerie; Stafford, Ashley; Allen, John G.; Shoukry, Emad; Wagner, Teresa; Greenlee, Quante; Turpin, ShirleyPurpose: The Affordable Care Act, calls for more focus on finding “innovative delivery systems that improve care, increase efficiency, and reduce costs” (Centers for Medicare and Medicaid Services, n.d., para. 4). The Safe Transitions for the Elderly Patients (STEP) program is a hybrid transitional care model developed to reduce readmission rates for Medicaid patients over 50 years of age in Tarrant County. Background: The STEP Program provides high quality transition of care services for discharged Medicaid elders of Tarrant County. A medical director, nurse practitioner, physician assistant, physical therapies, social workers, pharmacist, and nutritionist make up the in home care team. The foundation of the STEP Program was developed by the University of North Texas Health Science Center (UNTHSC) as part of an 1115 Waiver approved by CMS in 2012. The STEP Program is designed to improve the coordination and continuity of care for Medicaid patients 50 years of age and older transitioning from the hospital to the home setting following discharge. The primary goal of the STEP program is to identify discrepancies in transitional care and find solutions toward reducing all-cause 30-day hospital readmissions. Through the CMS 1115 waiver guidelines, we are also tracking patient BMI, smoking status, and pneumococcal vaccine status. Methods: The STEP Program will provide care transition services for 750 patients from October 1, 2013, to September 30, 2016, via referrals received from local hospital partners. STEP faculty and staff have developed evidence-based protocols and communication strategies aimed at meeting or exceeding performance metrics for reducing hospital readmission. The NextGen EMR is the primary means for gathering data for these metrics and assessing the impact of the evidence based protocols and communication strategies. Plan-Do-Study-Act methodology is used to regularly to evaluate and re-evaluate STEP Program practices to meet and exceed performance metrics, while improving overall performance. Current Results: The current 30-day readmission rate for patients enrolled in the STEP program is 9%, which is a significant improvement from the recent national readmission rate at 18.5% and Texas at 18.4% for Medicare specific beneficiaries (CMS, 2012). Conclusion: By reducing hospital readmission, the STEP Program can contribute to improving the quality of transitional care services as a sustainable practice model. This example of transitional care services can serve as a model to help reduce hospital expenditures, decrease hospital penalization for readmissions, and help provide quality outpatient management and coordinated care for this vulnerable patient population. Centers for Medicare and Medicaid Services. (n.d.). Section 1115 demonstrations. Retrieved from http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/Section-1115-Demonstrations.html Centers for Medicare and Medicaid Services. (2012). National Medicare readmission findings: Recent data and trends. Retrieved from http://www.academyhealth.org/files/2012/sunday/brennan.pdfItem Developing Interprofessional Collaboration to Advance Innovative Service Delivery in Geriatric Health Settings(2019-03-05) Severance, Jennifer; Saville, Neika; Hawley, Diane; Knebl, Janice; Johnston, LeahPurpose: Interprofessional collaboration is essential in geriatric healthcare settings due to the complex needs of older adults. The University of North Texas Health Science Center and Texas Christian University’s Harris College of Nursing partnered together to design the Geriatric Practice Leadership Institute (GPLI) ten-month training program with an aim of cultivating interprofessional team development and growth in order to enhance value-based patient-focused care to older adults in the developing primary healthcare systems. Methods: Leadership training and quality improvement strategies were integrated into curricula for health professionals (n=33) attending four one-day sessions held between September-December 2018. Content focused on 4 domains: 1) Leading Self and Interprofessional Teams to Drive Patient Outcomes; 2) Leading Organizational Change Toward Quality Outcomes; and 3) the Aging Network and Safe Healthcare Delivery for Older Adults. Teams developed a geriatrics-related quality improvement project in their area of practice with support from faculty and an assigned Coach. Evaluation surveys using Likert scale items were administered after each session. Open-ended responses were examined using qualitative thematic analysis. Results: Trainee feedback shows improved knowledge and skills in collaborating as a health care team to improve patient care and safety, and improved understanding of unique and shared roles and responsibilities and of ways to work collaboratively in patient care. Ninety-six percent better understand the need for a common language for team discussion and assessment, and 92% would recommend the training. Qualitative responses indicated the trainees intended to modify their professional practice as a leader and team member; and in the development, implementation, or evaluation of their project. Perceived challenges to meeting team goals include time restraints, coordinating schedules for group meetings, and stakeholder engagement within their organizations. Conclusion: Focusing on the development of interprofessional team collaboration and communication can foster development of interventions that improve geriatrics care in health systems. Interprofessional teamwork in conjunction with leadership training can produce rapid change in health practices. Projects developed within the GPLI are sustainable, providing continuous data collection for future use.Item Development of A Geriatric Training Certificate For Family Medicine Residents(2017-03-14) Young, Richard; Knebl, Janice; Severance, Jennifer; Smith, Don; Prasad`, Subhada; Hartos, Jessica; Hadley, LescaBackground: With a lack of Geriatricians, Family Physicians must be prepared to care for older adults and provide team-based care in different settings. However, geriatric training for Family Medicine Residents is inconsistent, and their comfort level in caring for elderly patients varies. To expand the Family Physician’s understanding and collaboration with community partners in geriatrics care, Family Medicine Residency Programs at JPS Health Network and Plaza Medical Center integrated community-based experiential learning modules into Y2 and Y2 curriculum as part of a new Geriatric Certificate. Methods: Residency Directors at JPS Health Network, Plaza Medical Center and UNT Health Science Center, faculty, and representatives from community organizations identified evidence-based practices providing experiential opportunities for residents. The enhanced curricula includes a 4-hour home visit with a Meals on Wheels client; a 4-hour home visit with an Alzheimer’s Association patient and caregiver; a 1-hour group session for A Matter of Balance fall prevention program; and a 1-hour Virtual Dementia Tour. Residents completed evaluation surveys using a 5-point Likert scale to assess the quality of training, knowledge of older patient needs, and attitudes towards geriatric patient care. After pilot testing the modules with Geriatric Fellows in the Spring 2016, the modules were implemented with Family Medicine Residents in Fall 2016. Results: 12 Family Medicine Residents completed Meals on Wheels home visits, 10 completed Alzheimer’s Association home visits, and 57 completed the Virtual Dementia Tour. 13 Plaza Medical residents completing the Virtual Dementia Tour completed evaluation surveys, and reported gaining confidence in their knowledge of healthcare needs, and increasing in knowledge of services for older patients. They also reported increased confidence in talking with older adults about needs and services. 92% recommended the training. Qualitative feedback revealed major themes, including residents’ increased awareness of patient care considerations, caregiver roles and greater appreciation for working with older adults. Conclusions: Results suggest that Family Medicine Residents benefit from experiential geriatrics training developed in partnership with community based organizations.Item Diastolic Properties in Older Mice: Comparison Between C57Bl6J and C57BL6N.(2017-03-14) Taffet, George; Acharya, Deepak; Reddy, Anilkumar; Yechoor, Poornima; Pham, Thuy; Hermosillo, Jesus; Harley, Craig; Knebl, Janice; Karim, SanaaPurpose: Cardiac aging in both humans and mice is associated with diastolic dysfunction, and impairment of the left ventricle filling. Age-related factors contributing to this filling impairment include fibrosis of the ventricle and impaired calcium handling by cardiomyocytes. Most aging studies use the C57Bl6/J (J mouse), but the C57Bl6/N (N mouse) has similar longevity without extensive cardiac fibrosis at comparable ages. Hence, this study is designed to identify the effect of fibrosis on diastolic function. Methods: We performed Doppler and 2-D echocardiography on fourteen 29 months old C57B16 (J and N’s) mice under 1% Isoflurane. The parameterized diastolic filling (PDF) formalism was used to comprehensively evaluate the diastolic dysfunction modeling the ventricle as a damped spring with spring stiffness (k), damping constant (c), initial stretch (x0). Small doses of Ivabradine were given to control heart rate for this assessment. Results: The N mice showed a c value of 205 ± 15, k of 7940 ± 530 and a xo of -.23 ± .004 in comparison to the J mice that showed a c value of 195 ± 14, a k value of 10,420 ± 800 and a xo value of -.016 ± .001. Conclusions: Though systolic function was preserved in old N’s and J’s, the spring stiffness (k) was significantly higher for the old J’s. This suggests fibrosis stiffens the old heart dramatically, but the larger LV diameter in the N’s suggests that fibrosis may prevent chamber enlargement with aging.Item FINDINGS FROM A THREE YEAR REVIEW OF MEDICAL STUDENT ATTITUDES TOWARD A GERIATRIC TRAINING PROGRAM AND AN EARLY PRACTICE MODEL IN THE CARE OF OLDER ADULTS(2014-03) Lane, Yolanda; Smith, Raina; Knebl, Janice; Marquez-Hall, Sandra; Eshon, ConstanceThis research study identified and evaluated the attitudes and confidence level of medical students’ knowledge, skills, and perceptions related to the health care of older adults. A survey was administered as a pre-test during first year orientation and then as a post-test after student exposure to a total of 163 hours of geriatric curriculum in Y1 and Y2. Information gained from this research could improve the development and delivery of medical education curriculum related to provision and care of older adults. Purpose (a): Between 2005 and 2030, the number of adults in the US aged 65 and older will almost double from 12% to almost 20% of the population, with those who are 80 and over, “the oldest old” expected to nearly double from 11 million to 20 million. This group, along with changes in the US Health Care System, will place increased demand on the patchwork of health care services due to the epidemic of chronic disease such as dementing disorders, arthritic conditions, diabetes, hypertension, and heart disease. The Reynolds Geriatric Education & Training in Texas (GET-IT) Program sought to better address the medical needs of the growing geriatric population. The two objectives of the study were: 1) Increase the content of geriatric education in the medical education curriculum; a total of 163 hours of geriatric education were added to Y1 and Y2; and, 2) Identify and evaluate the attitudes of student perceptions related to the health care of older adults in response to the geriatric curricular content. Methods (b): The study used a 52 item questionnaire Aging and Healthcare Survey Medical Students Perceptions that contains a 5-point Likert Scale for measurement. Surveys were administered twice over a three year period (2009-2011); once at orientation as a pre-test and again as a post-test at the end of Y2 after medical students were exposed to geriatric curriculum and the SAGE Program. A selected sample of surveys (n=95) were used for this review. Results (c): Only responses that contained significance at p ≤ 0.005 related to changes in student perceptions of aging and healthcare between Y1 and Y2 of medical school were included in this report. Selected Survey Items from Aging & Healthcare Study. 5= Strongly Agree; 4= Agree; 3= Neutral; 2= Disagree; 1= Strongly Disagree. Year 1 Mean. Year 2 Mean. P-value. Q14 There is not enough course content on the evaluation and care of older adults. 4.44. 2.70. < .001. Q21 I am comfortable talking with an older patient about their death. 4.20. 3.59. < .001. Q23 Physicians need to learn special skills to care for older patients. 4.23. 3.75. < .001. Q30 Learning about how to care for older patients should be a priority for people in Medicine. 2.53. 3.40. < .001. Q31 I know a lot about growing older. 2.12. 3.06. < .001. Q38 I would prefer not to provide medical care to older adults. 3.37. 2.52. < .001. Q29 Physicians need to understand issues of quality of life for an older adult. 3.03. 4.05. 0.002. Q16 As people become older, most become depressed. 3.19. 2.75. 0.004. Conclusions (d): Our findings showed some mixed results. Exposure to the geriatric curriculum had a positive impact on student’s awareness, understanding, and treating of older adults including psycho-social awareness. Students reported more confidence in and an appreciation of the need for communication with older adults in the areas medical history and quality of life issues but less confidence with older adults in areas of palliative care and end of life issues. The data obtained from the survey supports the integrative model of geriatrics curricula into undergraduate medical education.Item Geriatric Leadership Training For Health Professionals In Emerging Health Systems(2017-03-14) Fairchild, Thomas; Knebl, Janice; Smith, Don; Severance, Jennifer; Prasad, Subhada; Hartos, Jessica; Hawley, DianeBackground: Increasingly integrated health delivery systems require that healthcare practitioners work effectively in interprofessional teams and lead change in emerging health care environments. To prepare the next generation of leaders and in transforming geriatric systems of care, the University of North Texas Health Science Center, Texas Christian University’s Nursing and Business Schools and the United Way’s Area Agency on Aging of Tarrant County partnered together to develop a ten-month Geriatric Practice Leadership Institute (GPLI). Methods: Applying a Rapid Cycle Quality Improvement Approach, faculty developed curricula for three two-day sessions held in October, November, and December 2016. Curricular content focused on five domains: 1) Leading Self; 2) Leading Teams, 3) Leading Organizational Change, 4) Population Health Science, and 5) Aging Network and Healthcare Delivery for Older Adults. Six teams of 27 healthcare professionals were selected from JPS Health Network, Texas Health Resources, UT Southwestern, UNT Health Science Center, Brookdale Senior Living, and The Women’s Center. Teams developed a geriatrics-related quality improvement project in their areas of practice. Projects focused on caregiver support, combating isolation, fall prevention, and improving electronic health records systems. Coaches support project development. Evaluation surveys were completed by participants at the end of each session to assess the quality of the training, and its impact on project development, implementation, and professional practice. Results: The majority of respondents agreed the sessions were helpful for personal mindfulness of leadership attributes and skills, and in developing, implementing and evaluating their quality improvement projects. Qualitative responses indicate the trainees intend to make changes to their professional practice as a leader and team member. Comments include changes to “better define roles in the group setting to improve outcomes and efficiency” and “engage stakeholders.” Comments related to projects include changes “in the scope of the project to something more manageable and suited for our resources,” and to “identify the obstacles that may affect the success of the project.” 92% would recommend the training. Conclusions: Enhancing health professionals’ personal leadership skills can create meaningful interventions designed to improve geriatrics care in primary healthcare systems.Item Incorporating health literacy principles into student’s curriculum will improve confidence and overall ability to effectively communicate with older adults(2018-03-14) Nowamooz, Neika; Knebl, Janice; Yeager, ErickaPurpose: Adults over age 65 are at a higher risk for low health literacy. According to a survey from the National Assessment of Adult Literacy (NAAL), more than half of seniors (59%) have below basic literacy levels. In order to combat this issue, educating health professional students on health literacy strategies can increase the understanding of such disparities, and enhance communication capabilities with seniors. Methods: Students encompassing seven health professions between two universities (n=620) were assembled into interprofessional teams and assigned a senior mentor (n=171). The teams were asked to develop a presentation covering a designated health topic of their mentor’s choice using health literacy principles. Following the presentation, a sampling of the senior mentors (n=75) and all of the students involved were surveyed and results were evaluated for effectiveness. Among the older adults and students, the response rate was 91% and 75% respectively. Results: According to students surveyed, 70% agreed that as a result of this visit, they now understand how to effectively communicate with older adults using health literacy strategies. Seventy-four percent of students also felt more confident about their knowledge of health care needs for older adults.. When reviewing senior mentor responses, 98% said after the presentation, they feel better informed on the given subject. Additionally, 85% were able to recall two pieces of information learned, and 98% feel they will be able to apply what they learned from the presentation to their health. When estimating if any change had occurred because of the presentation, 98% of seniors said they experienced some amount of positive change. Conclusions: Application of health literacy strategies within interprofessional healthcare teams can have a positive effect on future communication and confidence when discussing health matters with older adults.Item Knebl, Janice, D.O.(1994-04-15) Knebl, Janice; Hailey, BlakeDr. Knebl is Associate Professor of Medicine for the Department of Medicine and Chief for the Geriatrics Division. She discusses her current and future work with the Health Science Center. Interviewed by Blake Hailey, April 15, 1994Item Lessons Learned from Age-Friendly, Team-Based Training(MDPI, 2023-08-25) Murphy, Sara C.; Severance, Jennifer J.; Camp, Kathlene; Knebl, Janice; Fairchild, Thomas J.; Soto, IsabelAccording to the Institute of Medicine, immediate steps must be taken across the United States to educate and train the healthcare workforce to work collaboratively to address the needs of the growing older adult population. The Geriatric Practice Leadership Institute (GPLI) was designed to support professional teams working in acute and post-acute care in transforming their organization into a designated Age-Friendly Health System. The program was built around the Institute for Healthcare Improvement's Age-Friendly Health Systems 4Ms framework. This framework focuses on What Matters, Medication, Mentation, and Mobility (the 4Ms) in supporting care for older adults. The GPLI program is an online, seven-month team-based program with four to seven participants from one organization per team. Additionally, each team selected, developed, and completed a quality improvement project based on Age-Friendly Health Systems 4Ms. The curriculum also includes organizational culture, leadership, and interprofessional team-building modules. Using a post-completion survey, the experiences of 41 participants in the GPLI program were assessed. All respondents found the information in the program 'very' or 'extremely' valuable, and their executive sponsor 'very' or 'extremely' valuable in supporting their team's involvement and project. The GPLI program has trained over 200 healthcare professionals and teams that have successfully implemented projects across their organizations.Item Preventing 30 Day Hospital Readmissions Through Predictor Identification(2017-03-14) Knebl, Janice; Allen, John; Larrabee, RachelIntroduction: Safe Transitions for Elderly Patients (STEP) is an in-home transitional care service for Medicaid eligible adults aged 50 and older with the goal of ameliorating the CMMS national average rate 21.6% (2013) of patients’ readmission to the hospital within 30 days of discharge. The purpose of the project is to identify potential modifiable clinical and non-clinical factors that will improve patient safety and reduce rehospitalization rates for this vulnerable population. Methods: The study design is a retrospective cohort study of data collected from 498 patients age 50 and older that were enrolled in the STEP program. Exclusion criteria from the original data includes all patients without a BMI assessment, a risk stratification, a transportation assessment, a living assessment, and anyone who was not asked about their primary care provider (PCP). The remaining data was analyzed with respect to readmission status, medical conditions, and risk stratification classification. Comparisons were analyzed using SPSS statistical software including chi-square testing and odds ratio analysis. Results: The readmission rate for the patients included in this study 19.5%. The odds ratio revealed that age greater than 65 (2.02, 95% CI 1.23-3.24), seven to eleven diagnoses at readmission (1.75, 95% CI 1.12-2.74), High Risk Stratification (2.81, 95% CI 1.70-4.63), CHF (2.00, 95% CI 1.22-3.28), and COPD (1.74, 95% CI 1.08-2.79) were each individually associated with higher odds of readmission within 30 days. Living alone was associated with lower rate of readmission within 30 days (0.53, 95% CI 0.30-0.93). Data collected that that proved to be statistically not significant included pain scale rating greater than 6, not having a primary care provider, limited transportation, diabetes mellitus type 2, obesity, and hypertension. Conclusions: The individual factors—age greater than 65, High Risk Stratification, CHF, and COPD—are significant predictors of readmission within 30 days post discharge within this population. Knowing about these factors will help design transition of care programs that target this high-risk population.Item Reducing falls in post-acute Medicaid patients enrolled in the Safe Transitions for the Elderly Patient (STEP) Program(2015-03) Johnson, Valerie W.; Camp, Kathlene E.; Lardner, Dana; Bugnariu, Nicoleta; Knebl, JanicePurpose: The STEP Program is a hybrid transitional care model composed of interdisciplinary team members focused on reducing hospital readmissions, decreasing falls, and improving quality of life. Thus far, no transitional care program has been able to show a significant reduction in falls among post-acute, community dwelling older adults. As the first physical therapy (PT) team to be included in a transitional care program, we sought out to identify potential fallers and reduce falls in this vulnerable population. The purpose of this paper is to evaluate the contribution of PT intervention in the STEP program, specifically as it relates to decreasing falls and falls risk. Methods: We utilized a qualitative, subjective report instrument known as the 4-point Hopkins Falls Grading Scale (HFGS) with good face and content validity to discriminate between the severity and frequency of falls. A systematic, subjective history of falls and comprehensive fall risk assessment scores pre- and post- PT intervention were obtained and analyzed. All data was analyzed using SPSS, and according to the Shapiro-Wilk test, none of the fall data was normally distributed (all yielding p-values of .000). Therefore, we used the Wilcoxon Signed Rank Test to analyze the difference in medians for pre-STEP fall data at 3 months and post-STEP fall data. Results: Preliminary data of a subset of patients reveals promising results for the Hopkin’s Falls Grading Scale with 3 out of 4 grades showing a significant reduction in falls. The Wilcoxon Signed-Rank Test provided the following results. There was a significant decrease in number of Grade 4 Falls (p = .000). There was not enough evidence to support a significant difference in number of Grade 3 Falls (p = .065). There was a significant decrease in number of Grade 2 Falls (p = .000). Finally, there was a significant decrease in number of Grade 1 Falls (p = .004). Grade 3 falls showed no significant difference; however in our distribution, we only had 8 patients that reported Grade 3 falls, compared to 20 patients for Grade 4 falls, 22 patients for Grade 2 falls, and 19 patients for Grade 1 falls. Conclusions: These results confirm the need and importance of collecting pre- and post- PT intervention falls data. At this point in time, 3 out of 4 grades show a significant decrease in falls. The data suggests that transitional physical therapy is effective in showing a reduction in falls in older Medicaid patients recently discharged from the hospital.Item Role of Physical Therapy in the Interdisciplinary Team for Safe Transitions for Elderly Persons (STEP)(2015-03) Camp, Kathlene E.; Johnson, Valerie; Bugnariu, Nicoleta; Lardner, Dana; Knebl, JaniceBackground: Managing an effective transition from hospital to home is challenging due to the medical complexity of multiple diagnoses and care needs, especially in low income seniors. Early hospital readmission has been linked with many factors, including impaired mobility and ineffective management of diseases. Physical therapy (PT) can have an impactful role on addressing safety with mobility and supporting education on disease management. Purpose: The purpose of this report is to describe the role of PT on an interdisciplinary care team, describe the PT intervention, highlight fall risk assessments and results, and identify leading environmental hazards and supports that can impact fall risk. Methods: The STEP care team was comprised of a medical director, nurse practitioner or physician assistant, social worker, physical therapist, pharmacist and registered dietician. PT performed a comprehensive evaluation, appropriate fall risk assessment, and home safety evaluation. Recommendations and assistance were provided to improve home safety, education and intervention were implemented to address specific needs to improve safety with mobility, care was coordinated with home health resources, and community resources were utilized to access additional needs not met by insurer coverage. Final assessments were made at time period of 30+ days in accordance with successful transition in medical care. Results: 126 out of 161 patients enrolled into the STEP program received PT. Patients were in the STEP program for an average of 42 days and received an average of 3 PT visits. The most prevalent home safety hazards identified were lack of grab bars (45%), lack of supportive equipment for shower/tub (42%), unsafe bathroom tub/shower surfaces (30%), narrow/cluttered pathways (33%), and cluttered/soiled living areas (30%). The most common supports were adequate lighting (39%), appropriate commode height (58%), stable/supportive seating (40%), clear/accessible walkways (44%), and secure floor coverings (38%). Home modification opportunities were greatest for adjustment of commode and seating heights (79%, & 2%), providing adequate lighting and chair dressing support (60%), securing floor coverings (50%), and installing night lights (50%). For ambulatory clients, fall risk assessments indicated 96% were at risk for falls. There was an average of 9% of hospitalizations in the first 30 days; however none were related to falls. Conclusion: Reasons for falls are multifactorial and require an interdisciplinary approach to have effective reduction in risk. PT has a significant role in this reduction by addressing both the physical impairments and the environmental factors. Interprofessional collaboration on patient performance in the home can be instrumental in avoiding falls and preventing early hospital readmissions for this high risk population.Item Seniors Assisting in Geriatric Education (SAGE): Reynolds Program addresses the lack of training in geriatrics and provides a model for interprofessional education.(2015-03) Marquez-Hall, Sandra; Lane, Yolanda; Knebl, JaniceSeniors Assisting in Geriatric Education (SAGE) is a program that helps healthcare students develop competency with older adults and strengthen their clinical applications of medical education through an interprofessional team experience. Two objectives for this study: 1) To increase development of competency in attitudes, knowledge, and skills in the care of older adults; and, 2) To provide an Interprofessional experience where students learn about, with, and from collaborating as a team member in the context of working with an older adult. Senior volunteers 60 years and older are mentors in the program. Student teams meet with senior mentors in their homes for a series of home visits over the course of a two year period. SAGE curriculum guides program content and is delivered through an online learning system. Student teams conduct eight home visits which include conducting environmental home safety and nutritional assessments; medical history, physiology of aging, bio-psychosocial interviews; medication reconciliation, review of community resources, and end of life issues. A survey was administered to students to evaluate perceptions of learning after participating in the SAGE Program; this is a self-report model. A quantitative survey using a five-point Likert Scale evaluates student perceptions of learning. Findings (n=332) revealed modest levels of student confidence and attitudes toward geriatric patients (3.6), and comfort in performing physical examinations (3.5). Higher levels were found in recognizing unique medical and psycho-social issues (3.8); competency in interviewing, physical assessment and examination skills (3.8); and practice using ADLs and IADLs (3.8). Highest overall scores were found in environmental home safety and falls risk (3.9); use of Mini-Mental Status Exam (3.9); and real world experience (4.0). The SAGE experiential learning program provides insight into medical student perceptions toward older adults using a senior mentoring and home visit model. Medical education in geriatrics combined with experiential learning in student teams resulted in modest improvement in student perceptions of confidence and patient interaction.Item The Impact of Guided Reflection in the Professional Development of Medical Students in the Context of Death and Dying.(2016-03-23) Martin, Roy; Knebl, Janice; Hsu, Jennifer; Marquez-Hall, SandraStatement of the Hypothesis Medical students often struggle with end-of-life issues. To address this need, two educational sessions about death and dying were introduced to fourth year medical students during their Core Geriatric Clerkship. The curriculum included the use of guided reflection, which involves facilitated discussion and reflective writing, to help students identify and cope with their feelings about death and dying. Many students had reported struggling to identify their role as a health professional related to the topic of death and dying. This study explores the impact of helping students reflect on their understanding of a medical professionals role in death and dying. Brief Summary of Materials and Methods The idea for this project originated from the results of a previous study conducted by the Reynolds Geriatric Education and Training in Texas (GET-IT) program. A pre- and post-survey was administered to fourth year students (n-805) prior to the start and again at the end of the 4 week Core Geriatric Clerkship. The survey found that students felt less comfortable discussing palliative care and end-of-life issues after exposure during the rotation (pre-test mean: 4.20, post-test mean: 3.59, p A Summary of the most pertinent, significant results As part of their core geriatrics clerkship, fourth year medical students were required to attend two sessions on end-of-life care that included lecture, guided discussion, community resources and a reflective writing assignment. The follow-up self-assessment survey greatest improvement in competency was end-of-life care. In the pre-test students had reported 1.96 average mean in their comfort level related to End of Life Care; and, after participation in the revised curriculum, students reported an average mean score of 3.02. This findings indicate that the average student now feels they have “significant ability” to talk about end-of-life issues. Conclusions derived from the presented data Fourth year medical students at UNTHSC were found to have struggled with communication related to palliative care and end-of-life issues. By providing a safe platform for review and communication on end of life issues, the study found that students reported improved confidence in the ability to cope with death and dying. While 150 minutes of instruction cannot fully prepare students to cope with these difficult and sensitive issues, students can gain confidence in this area of their professional role as future physicians. Through peer support and faculty feedback, the guided reflection increased students’ belief in their own competence, freeing them to use their unique life experiences and skills to cope with death and dying.Item Types of Telehealth services preferred by geriatric patients during the COVID-19 pandemic(2022) Nguyen, Matthew; Escobar, Krystal Cruz; Knebl, Janice; Garfield, TysonTechnologies' growing involvement in health care has led to continuous improvement in access, efficiency and quality of care, but specific challenges lie with addressing the barriers that impair the geriatric population from benefitting the use of new technology.1 The purpose of this quality improvement initiative was to obtain feedback from older adults and their caregivers regarding the usage of telehealth services during routine clinic care and their preferences for each type of visit. A convenience sample survey was administered to 55 geriatric patients older than 50 years old between June - October 2021 who have their medical at the University of North Texas Health Science Center - Center of Older Adults' ambulatory clinic. The survey included questions about the patients' demographics, the survey taker's relationship to the patient if not the patient, and their experiences with telehealth services. Additionally, the survey included questions using a Likert scale where the patient or caregiver ranked types of clinical visits they would prefer telehealth services for versus an in person clinic visit. Responses from the participants were compared based on the types of visits. Of the 55 respondents to the survey questionnaire, 37 were females and 18 were males and 45 were the older adult patients, 9 were family member caregivers and 1 non-family caregiver. The results indicated that the majority of patients and caregivers preferred the following types of visits as a telehealth visit: reviewing prescriptions, review of laboratory results, blood pressure management, and questions/screening about COVID-19. All other types of clinic visits, such as routine clinic visits for chronic conditions, acute illness symptoms, acute or chronic pain conditions, psychosocial needs and advanced care planning were preferred to be done in person. When asking about their experiences with telehealth services, geriatric patients used the telephone the most often for their medical needs. These findings indicate that geriatric patients prefer to continue traditional in person clinic visits for their acute and chronic disease management but are open to having discussions about their laboratory values, blood pressure management, reviewing medications and Covid-19 screening through telehealth. The high telephone telehealth usage suggests that the majority of geriatric patients are not comfortable and familiar with other forms of telehealth that includes the use of virtual platforms that has developed over recent years. Although telehealth cannot be used as a means to replace in person visits, it has been shown to have a place in clinical care for geriatric patients and their caregivers depending on the clinical needs.Item Workforce Enhancements in Healthy Aging and Independent Living(2016-03-23) Severance, Jennifer; Hartos, Jessica; Mize, Joanne; Prasad, Subhada; Carter, Elizabeth; Hadley, Lesca; Hawley, Diane; Smith, Don; Cisneros, Alexandra; Knebl, JanicePurpose: Older adults are among the fastest growing age group in the United States and use many health care services, have complex conditions, and require professional expertise to meet their health care needs. Having a geriatric workforce capable of carefully managing the medical conditions of seniors to assist with healthy independent lifestyles is important. The University of North Texas Health Science Center expanded unique partnerships with Texas Christian University, JPS Health Network, and United Way’s Area Agency on Aging to create the Workforce Enhancement in Healthy Aging and Independent Living (WE HAIL) Program. As the only Geriatric Workforce Enhancement Program awarded in Texas, WE HAIL advances geriatric education by aligning learning objectives and activities with community needs of an aging population. Program innovations take cross-sector approaches to integrate evidence base programs into health professional training, and expand training opportunities for rural areas and underserved populations. Applying a Rapid-cycle Continuous Quality Improvement (RCQI) method, WE HAIL provides training enhancements for the following learner groups: 1) undergraduate and graduate students; 2) faculty; 3) family medicine residents; 4) practicing health care professionals, including physicians, nurses, physician assistants, pharmacists, physical therapists, social workers, and dieticians; and 5) caregivers of older adults. Methods: Data will include trainee demographic information through the HRSA-GWEP Performance Report for Grants and Cooperative Agreements (PRGCA), feedback from trainees on usefulness, intention to use, and suggestions for future activities, and pre-post measures for practitioner knowledge, skills, and effectiveness. Additional data includes older adult outcomes from program-specific validated tools, and cross-program measures using Centers for Disease Control Healthy Days (4-items) and National Health Interview Survey Utilization (4-items). Results: Five Innovation teams of interprofessional faculty and community organizations, including Meals on Wheels, Senior Citizen Services, Alzheimer’s Association and James L. West Alzheimer’s Center, convened to plan and develop enhancements in existing programs. New programs are proposed for a Geriatric Certificate for Family Medicine Residency Programs, and a Geriatric Professional Leadership Institute. Proposed enhancements and new programs will be implemented during 2016-2018 to impact over 2,000 health professions students, almost 100 family medicine residents, over 500 primary care practices, and over 2,000 older adults and their caregivers. Conclusions: WE HAIL collaboration will deliver quality training enhancements and increase the number of geriatric-trained primary care providers to meet the needs of older adults at individual, community and population levels.