Browsing by Author "Severance, Jennifer"
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Item A Matter of Balance Fall Prevention Program Delivery to Underserved Populations(2021) Khan, Amal; Quach, Shanon; Rivera, Solymar; Severance, JenniferPurpose: Falls are the leading cause of injuries in older adults. A Matter of Balance (AMOB) is a national evidence-based fall prevention program. However, there is a lack of implementation to underserved populations. This study investigates the impact of cross-sector partnership delivery of AMOB on 1) access to serve underserved older adults in Tarrant County, Texas and 2) older adults' confidence in their ability to manage falls. Methods: Area Agency on Aging, Sixty and Better, University of North Texas Health Science Center, and Medstar collaborated to deliver AMOB in Tarrant County zip codes with the most emergency calls for falls in older adults. 354 older adults voluntarily participated and were surveyed for demographics and self-rated confidence in their ability to manage falls using the Falls Efficacy Scale (FES). Results: The average age was 78 ± 8.33 and most participants were female and white non-Hispanic. 49% of the programs were in hotspot zip codes and 31% of the participants were from hotspot zip codes. 53% of the participants completed the program and 48% of those who did not complete was due to COVID-19. Confidence in managing falls (t=-8.222, p< 0.001) increased significantly with program completion. Conclusions: AMOB was effective in increasing confidence in managing falls for individuals who completed the program. Using zip code data is helpful in planning outreach, but less than half of the participants were in the desired areas. To address access barriers, stakeholder groups that represent underserved communities should be included.Item Assessing Cognitive Function: The Role of the Memory Alteration Test in Predicting Stroop Color-Word Performance within the Self-Management Program for Brain Health(2024-03-21) Aboutaj, Amin; Ross, Sarah; Soto, Isabel; Severance, JenniferPurpose: The Self-Management Program for Brain Health is designed to empower participants to make lifestyle changes that enhance cognitive function and potentially delay dementia onset. This study investigates the predictive relationship between the Memory Alteration test and Stroop Color-Word (Stroop CW) performance in these participants, aiming to contribute valuable insights to the complex interplay between memory and executive processing abilities. Methods: Cognitively healthy adults (n = 21, age range 56–90) participated in the study, meeting inclusion criteria and undergoing vital sign assessment, Memory Alteration, and Stroop CW tests. The Memory Alteration test, a reliable screening tool, employed a cut-off of < 40 for cognitive impairment. Stroop CW raw scores were age-corrected, and T-scores were obtained. Statistical analyses included correlation coefficient (r) and p-value calculations. Results: A statistically significant positive correlation (r = 0.55, p = 0.009) between Memory Alteration and Stroop CW scores was observed. Subgroup analysis confirmed the hypothesis, revealing a consistent correlation pattern for those scoring below (mean Memory Alteration 37.86±0.55, Stroop CW 48.43±2.32, r = 0.88, p = 0.009) and above (mean Memory Alteration 44.93±0.85, Stroop CW 50.79±1.89, r = 0.67, p = 0.009) the normal Memory Alteration cut-off of 40. Conclusions: The study supports the predictive ability of the Memory Alteration test on Stroop CW performance in cognitively healthy adults. It underscores the clinical relevance of the Memory Alteration test as a reliable screening tool for early cognitive impairment and processing speed changes. Clinicians are encouraged to become familiar with the Memory Alteration test, considering its inclusion as an additional cognitive screening tool. By adding this brief and non-invasive assessment into routine practice, healthcare professionals can enhance their ability to identify subtle cognitive changes early on, facilitating proactive interventions and contributing to improved patient outcomes. Limitations include sample size and variability, suggesting the need for larger, more diverse samples in future research. The ongoing Self-Management Program for Brain Health presents an opportunity to address these limitations and advance our understanding of cognitive assessment and brain health.Item Assessing the Utility of the Project ECHO Platform in Advancing the Knowledge, Skills and Abilities of the Healthcare Workforce to Improve the Health of Older Adults(2022) Ausman, Jessie; Jose, Roslin; Severance, Jennifer; Luk-Jones, Susanna; Ross, SarahPurpose: The population of older adults aged 65+ years is expected to increase by 262.9% from 2010 to 2050, thus significantly straining the geriatric care and long-term care (LTC) workforces. In addition to this, the COVID-19 pandemic has exacerbated existing strains placed on these workforces. To address these issues, the University of North Texas Health Science Center (UNTHSC) Center for Older Adults partnered with the Extension for Community Health Outcomes (ECHO) Institute to develop training and education for the LTC and geriatric care workforces. Methods: UNTHSC hosted weekly Nursing Home STRONG (NHS) ECHO training sessions targeted to LTC staff and bi-weekly Geriatrics ECHO training sessions targeted to geriatric providers. Virtually delivered NHS sessions featured specialist-led didactic presentations followed by interactive breakout discussions surrounding dementia care, IPC, workforce considerations, quality improvement, and age-friendly healthcare. Geriatric ECHO sessions followed a slightly different format; specialist-led didactic presentations were generally shorter with more time devoted to case study discussions. Topics covered during the Geriatric ECHO sessions included various aspects of dementia and cognitive impairment. Participants in both the NHS and Geriatric ECHO programs completed post-session surveys to track changes in knowledge, skills, and abilities using a five-point Likert scale. NHS participants completed a single post-session survey, while Geriatric ECHO participants completed bi-weekly surveys following the completion of each didactic session. Results: Between September 2021 and November 2021, 54 unique attendees representing 35 LTC organizations from 20 counties participated in NHS ECHO sessions. Importantly, 9 of the counties (45%) reached by the NHS ECHO were rural. A total of nine, 1-hour sessions were presented with an average of 17 attendees (excluding staff/facilitators), primarily including administrators (29.6%) and nurses (29.6%). Post-session respondents (n=10) "strongly agreed" that their knowledge of approaches to meet resident healthcare needs improved (90%), their knowledge of IPC improved (80%), and their ability to care for residents improved (80%) after attending at least one session. During this same time-period, 48 unique attendees representing 21 organizations participated in Geriatric ECHO sessions. A total of four, 1-hour sessions were presented with an average of 12 attendees, primarily including physicians (35.4%) and nurses (12.5%). Post-session responses indicated that majority of respondents "strongly agreed" that the session provided practical suggestions that can be applied in their practice (66.7 - 84.2%), the didactic topic was relevant to their learning needs (74.1 - 86.4%), and the case discussion was relevant to their learning needs (70.4 - 86.4%). Conclusions: Amidst various factors that increase burden on the healthcare workforce, the Project ECHO model offers an innovative virtual platform to adequately prepare diverse healthcare workforces to care for an aging population. This model has strong potential to improve future healthcare training and quality especially due to two unique features; collaborative, discussion-based instruction and the capacity to reach diverse and rural populations. Post-session survey responses suggested that the knowledge, attitudes, and skills of ECHO participants were improved via attendance in the NHS and/or Geriatric ECHO sessions.Item Consumer Needs for Long-Term Services and Supports and the Road to Improving the Texas No Wrong Door System(2024-03-21) Anaab, Esme; Murphy, Sara; Yockey, Robert; Severance, JenniferPurpose: Long-term services and supports (LTSS) encompass a broad range of medical and personal care assistance needed by individuals who are unable to perform self-care tasks due to aging, chronic illness, or disability. The No Wrong Door (NWD) System is a statewide network that coordinates the system of access to long-term services and supports. As an offshoot of the person-centered planning movement, the NWD System is premised on ensuring that no matter where individuals first interact with the system, they are guaranteed comprehensive information, assessment, and services. The primary goal of this work is to identify strategies to optimize coordination between and awareness of the entry points of this system. The evaluation will help the Texas Health and Human Services Commission create a consumer-driven, cost-effective, and efficient system. Methods: Qualitative input was captured through listening sessions in five Texas cities (i.e. Amarillo, El Paso, Fort Worth, Pharr, and San Antonio) which were supplemented with a statewide survey launched in September 2023 to derive understanding from experiences with the NWD System. Target audiences included people with disabilities, veterans, adults aged 50 and over, family caregivers, and LTSS providers. Several tools (e.g., telephone, mail, and Internet) were utilized for increased survey accuracy and response rate. The survey was distributed in both English and Spanish, and a specific QR code and survey link was incorporated to track responses. Results: Of 4,185 survey respondents, 69% self-identified within the target group (excluding LTSS providers), and 61% expressed a need for LTSS in the past year. Of the 52% who applied for LTSS, 44% stated use of LTSS daily, and 14% weekly. The top three problems accessing LTSS include a confusing system, long wait times for services, and not knowing where to get help. 79% of consumers were unaware of the NWD System; 2% unsure. Of the 19% aware, 45% felt very or somewhat uninformed about the system in their community. The reasonability of time spent applying for services, ease of applying for services, and timeliness in handling service concerns were among the lowest-scoring statements regarding the system. Conclusions: Our results form the blueprint for facilitating access to care at the community and agency levels throughout Texas to ensure vulnerable populations obtain a high quality of life. Recommendations for the NWD system include effective community outreach and streamlined application processes for services and supports.Item 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 Effects on Stroop performance pre-and post-participation in the self management brain health coaching program(2022) Kannan, Srijaa; Ross, Sarah; Quiceno, Mary; Severance, Jennifer; Jose, Roslin; Clark, EmilyPurpose: About ¼ of adults age 65 and older develop cognitive impairment without dementia. Of those who live past 85, 1/3 will develop some form of dementia. Currently, there is no cure for dementia. While developing dementia may eventually be unavoidable, various factors contribute to the onset of dementia including lifestyle choices. Modifiable risk factors related to lifestyle can be addressed through health coaching. The purpose of this study is to implement a program that supports participants in making lifestyle changes that will help them function optimally now, and promote brain health and cognitive functioning in the future to help reduce their risk of developing dementia. Methods: This is a longitudinal study design in which participants are measured multiple times throughout their participation. Health coaching, education, and targeted assessments with feedback are used to provide a personalized approach to addressing brain health. Program participants received in-person health coaching across a 3-month period. Study participants must be ≥18 years of age, with no dementia or uncontrolled psychiatric illness. Participants complete survey assessments for each of the seven pillars of Brain Health: Diet, Exercise, Social Engagement, Cognitive Activity, Sleep, Mindfulness & Outlook, and General Health. Additional information collected includes demographic information and assessments of cognition. The Stroop test is a cognitive assessment that measures attention, executive functioning, and processing speed. The Stroop test was performed prior to the start and upon completion of the program; pre and post participation results were evaluated for correlations. Results: Of the 36 participants who enrolled and completed the pre-surveys for the program, 25 progressed to participate in health coaching visits with personalized brain health lifestyle goals. The average age of participants is 76. 80% of the participants are female and 94% are Caucasian. The majority of participants chose improving cognitive activity as their area of focus. Feedback from those who completed the program has been positive. Participants stated that the program length met their need for implementing change, they would recommend the program to others, and they had positive experiences with the health coach. All participants who have completed the program to date have shown an improvement in the Stroop Test raw scores for words and colors comparing the initial intake visit to the closure visit. 50% of participants showed some improvement in the color-word raw scores. Conclusion: Participants in the self-management program for brain health show improvements in attention, executive functioning, and processing speed as measured by their performance on the Stroop test. As individuals make improvements in the seven pillars of brain health, they can expect optimization of cognitive functioning and risk reduction for developing dementia. The program allows individuals to focus on the areas of most importance to them, which contributes to their success. Recommendations for future studies includes tracking participants longitudinally with an aim to assess program benefit in preventing and delaying the onset of dementia.Item Evaluating A Matter of Balance Series for Fall Prevention in Rural Texas: Findings and Implications(2024-03-21) Lemack, Bergen; Murphy, Sara; Crocker, Andrew; Severance, JenniferPurpose: Nearly one-third of US adults over age 65 fall annually (CDC, 2023) and falling continues to be among the leading causes of unintentional injury death in Texas (Texas DSHS, n.d.), necessitating interventions that address confidence, physical activity, and awareness. In response to these challenges, the A Matter of Balance series has been designed to enhance the well-being of participants in rural Texas by addressing these crucial components. This study seeks to evaluate the effectiveness of the A Matter of Balance series in mitigating the impact of falls among older adults in rural communities. Methods: A secondary analysis was conducted on 164 surveys collected from A Matter of Balance participants in 2023. All participants were from counties meeting the Health Resources and Services Administration (HRSA) definition of rural, and the project received grant funding from HRSA. A paired t-test was used to compare scores on a pre-post test design. The study focused on measuring improvements in knowledge about ways to reduce falls, protecting yourself if you fall, increasing physical strength, becoming steadier on your feet, and getting up if there is a fall. The analysis aimed to provide insights into the impact of the A Matter of Balance series on the well-being of participants. Results: The findings of the study indicate significant improvements in participants' well-being because of their engagement in the A Matter of Balance series. Statistical analyses demonstrated substantial enhancements in knowledge about ways to reduce falls (p <.001), protect yourself if you fall (p <.001), increase physical strength (p <.001), becoming steadier on your feet (p <.001), and getting up if there is a fall (p <.001). These results collectively underscore the effectiveness of the A Matter of Balance series in addressing key parameters related to fall prevention. Conclusion: In conclusion, the A Matter of Balance series proves to be a successful intervention in enhancing the well-being of participants in rural Texas. By adopting increased confidence, reducing concern, and promoting physical activity, the program addresses the challenges associated with falls among older adults. These positive outcomes support the continued dissemination of the A Matter of Balance series, emphasizing its potential to contribute to the overall health and quality of life of older adults in rural communities.Item Evaluation of Team STEPPS training in Skilled Nursing Facilities(2019-03-05) Ross, Sarah; Severance, Jennifer; Agena, Valerie; Oderberg, Jane; Sang, NancyPurpose Skilled nursing facilities (SNF) face many challenges in providing safe and competent care to a frail population. Surveys of SNF staff reveal poorer levels of safety culture compared to their hospital counterparts. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based interprofessional training program designed to teach tool to promote teamwork, communication, and patient safety. Implementation of TeamSTEPPS has led to improvements in patient safety culture in hospital settings, but there is a lack of evidence of benefit of TeamSTEPPS in SNF. Method Our research team adapted the TeamSTEPPS curriculum for implementation at two area SNF. We conducted three TeamSTEPPS training sessions to direct care staff (n=139). The trainings were delivered between October 2017 and June 2018. Focus group sessions comprised of the direct care staff (n=119) were then conducted at each facility between August and September 2018. The questions asked focused on staff perception on using communication tools, the training program itself, and feedback on program improvements. The comments from each of the sessions were than categorized to overarching themes. Results Thematic analysis of responses resulted in six major themes, communication, accountability, leadership/authority, implementation of the training, need for training and burn out. A majority of the comments from both facilities focused on the implementation of the training, communication, and accountability. Staff comments about the training implementation were positive and that they enjoyed the delivery method of the training and were able to apply the training to practice. Staff acknowledged that the communication tool led to improvements in communication between the staff from different shifts. Staff members also noted that they became more aware of their own roles and accountability to patient safety. Conclusion TeamSTEPPS training was well received by the direct care staff, and there were reports of improved communication and safety awareness. We anticipate that as direct care staff at SNF use TeamSTEPPS tools a positive impact will be seen on patient safety culture. Considerations for implementation of TeamSTEPPS tools in SNF requires a tailored approach. Barriers to success include high turnover in both leadership and direct care staff.Item Expansion of a Fall Prevention Home Assessment Program in Partnership with Faith Community Nurse Program(2017-03-14) Robbins, Amanda; Camp, Kathlene; Severance, Jennifer; Mannala, SamanthaBackground: With the Fort Worth Fire Department (FWFD) receiving approximately 3500 calls last year related to falls at home, collaborative efforts are needed to combat this high prevalence of falls in the community. Fort Worth Safe Communities Falls Prevention Task force (FPTF) expanded their fall prevention programs in the community by providing home and environmental safety education for faith communities. Members of the FPTF developed and evaluated a training for Faith Community Nurses. Methods: Trainees were recruited by Texas Health Resources’ Faith Community Nursing Program to participate in a three-hour training provided by the FPTF. Participants received information about fall hazards and community resources related to fall prevention. Participants received training on using the FWFD’s home evaluation assessment tool and practiced using this tool to identify fall hazards in a room decorated to stimulate a home environment. Pre and post evaluation surveys asked trainees to assess the overall quality of the training, and rated their knowledge and skills using a pre-post 4-point Likert-scale. Results: The participants rated their knowledge of fall risks, fall factors, the FWFD’s home assessment tool and community resources that prevent falls before and after the training. In all areas, participants’ knowledge and confidence level increased after the training. The biggest increase came in knowledge in using the home assessment tool, with the average on the 4-point scale, increasing from a 2.21 to a 3.77. The next largest increases came in awareness of the factors that lead to falls (3.00-3.62) and talking about community resources for preventing falls (2.50-3.15). The smallest increase came in identifying fall risks, which increased from a 3.07 to a 3.54. 78.5% of the participants also agreed or strongly agreed that they felt more confident and planned to continue helping older adults. 100% agreed or strongly agreed that they would recommend the training. Analysis of qualitative feedback indicated the resources provided in the training, and the sample fall room were very helpful in learning about falls. Conclusions: Results suggest that Faith Community Nurses benefit from this training, based on the increases in knowledge of falls and confidence in helping older adults. This training will allow for expansion of the home safety assessment component to fall risk reduction in the faith community.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 Geriatric Practice Leadership Institute (GPLI): An Age-Friendly Program(2023) Murphy, Sara; Soto, Maria; Camp, Kathlene E.; Severance, Jennifer; Fairchild, ThomasPurpose According to the Institute of Medicine, immediate steps must be taken to educate and train both the current and future health care workforce to work collaboratively in addressing the diverse needs of the growing older adult population. Most healthcare professionals had very little education or clinical training in the care of older adults nor the most effective ways to work as a clinical team. Methods The Geriatric Practice Leadership Institute (GPLI) is a collaboration between two universities providing interprofessional teams of early and mid-career professionals with the skills and knowledge needed to leverage leadership skills to effectively work within interdisciplinary teams to provide age-friendly care to older adults. The GPLI incorporates the Institute for Healthcare Improvement (IHI) Age-Friendly Health Systems 4Ms’ Framework into the training. The GPLI is an on-line, team-based program which engages 5-7 teams each session. Module topics include Age-Friendly Health Systems, organizational culture, leading self, leading interprofessional teams, and quality improvement. Additionally, teams select and complete a quality improvement project based on the Age-Friendly Health Systems 4Ms and submit final report and presentation. The teams are also assigned a coach for support. Continuing education credits and a micro-credential are available to participants. Participants complete a survey following the completion of the program. The GPLI has been funded by the Health Resources and Services Administration (HRSA) Geriatrics Workforce Enhancement Program grant (numberU1QHP2873), which currently covers all costs for participants. Results The GPLI has trained over 175 healthcare professionals during the past 7 years with teams representing ambulatory to emergency responder organizations. Participants were all asked to complete a survey to gauge the program's success. When asked about how valuable the information was in the program in a post-completion survey, 100% of participants answered 'very’ or 'extremely’ valuable. Additionally, all participants answered either 'very’ or 'extremely’ valuable when asked how useful their executive sponsor was in supporting their team's involvement and project. Conclusion After many years of offering the program, many lessons have been learned, and consistent themes have emerged from the teams who have been the most successful. These include team representation from all levels of the organization, a focus on culture change, and flexibility to change and adjust, especially during the COVID-19 pandemic.Item Impact of an Evidence-Based Fall Prevention Program relayed by Physical Therapy Students on the Older Adult Population of Tarrant County(2017-03-14) Severance, Jennifer; Bartha, Christina; Lopez, GladysIntroduction: A Matter of Balance (AMOB)/Volunteer Lay Leader (VLL) Model is an evidence-based fall prevention program for older adults. Each class consists of eight two-hour sessions designed to increase confidence in fall management and physical activity. Senior Citizen Services of Greater Tarrant County (SCSTC) hosts the program across Tarrant County and has partnered with the University of North Texas Health Science Center (UNTHSC) to train physical therapy students as lay leaders. This study uses pre- and post-survey data from older adult AMOB participants to evaluate the impact and effectiveness of this partnership during the 2016 year as a part of continuous quality improvement. Methods: SCSTC collected data from program graduates using pre- and post-program evaluation surveys distributed at the beginning and end of each class. Surveys included the Falls Efficacy Scale (FES) to measure confidence in fall management. Class attendance logs provided information about class frequency, location and zip codes. Results: Ten classes were held at eight senior centers and one senior housing community. 24 zip codes were served. 106 of 136 participants (78%) completed the program. The majority of graduates were between the ages of 65 and 74 (51%), female (85%), and Black or African-American (61%). 58 graduates listed their primary language as English, 2 listed Spanish, and 1 listed Filipino. The average number of classes attended by graduates was 7. Graduates averaged a higher FES score (3.22) than all of the enrollees (3.13) at the end of the program. Conclusions: The averages FES scores for both enrollees and graduates increased, indicating that participants reported a greater level of confidence in managing falls. This finding confirms the efficacy of the VLL model of the AMOB program. The majority of graduates were women, African-American, and between the ages of 65 and 74. SCSTC’s partnership with UNTHSC students was effective in delivering the AMOB/VLL program to older adults in Tarrant County.Item Implementation of TeamSTEPPS For Patient Safety In Long Term Care Settings(2017-03-14) Severance, Jennifer; Ross, SarahPurpose: Patient safety is a recognized component to reducing hospital readmissions and preventable adverse events, although little is known about improving patient safety in skilled nursing settings that have an increasingly frailer and more dependent patient population due to shorter inpatient hospital stays. With a long term goal of improving the safety and quality of care provided to skilled nursing facilities (SNF), the University of North Texas Health Science Centers’ Center for Geriatrics will use a case study method to evaluate factors related to the implementation of a patient safety improvement intervention in SNF. Methods: The research team will review SNF data from secondary data sources reporting on CMS quality measures over a twelve month period to assess facility characteristics and facility performance and patient outcomes against national benchmarks. The research team will develop and implement the TeamSTEPPS Long Term Care program at the two SNF in Fort Worth, Texas, with each case defined as an individual facility. The research team will work with SNF leadership, including the Medical Director, Director of Nursing, and a licensed administrator. Implementation will occur in three phases outlined by the TeamSTEPPS program: Phase 1) conduct the patient safety culture assessment using the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Culture Survey; Phase 2) develop performance goals and an action plan of delivering customized training on patient safety areas prioritized through the data review and patient safety culture assessment; and Phase 3) conduct patient safety training and monitor performance of action plan items. Research team members will conduct open-ended and structured interviews with facility staff to gather data on their opinions about processes and facts related to implementation. The research team will also document activities in each phase of implementation. This exploratory data will be combined with process measures established during the action plan phase to conduct a holistic investigation of the implementation processes. Results: Research will be conducted at Trinity Terrace and Brookdale Cityview skilled nursing facilities in Fort Worth, Texas. Quality improvement teams will be formed at each center to complete the TeamSTEPPS training and monitor the implementation of patient safety initiatives that increase the capacity of skilled nursing facilities to implement team approaches in quality improvement activities, and increase the ability of skilled nursing facilities to improve patient safety. Conclusions: This exploration of TeamSTEPPS implementation will develop a replicable model of implementation to improve patient safety in SNF that will improve the health status of skilled nursing facility patients.Item Implementation of the HomeMeds Medication Management System in a Primary Care Setting(2018-03-14) Severance, Jennifer; Elrod, Shara; Chou, EvelynPurpose: HomeMeds, an electronic medication management system, has been shown to prevent and reduce adverse effects of medications in the elderly by reconciling medications and looking at cardiovascular, psychotropic, nonsteroidal anti-inflammatory drug (NSAID), or duplication problems. The program was originally designed and tested for use in a home setting, but less is known about use in a primary care setting, and few studies can link the intervention to patient health outcomes. Methods: A retrospective analysis was performed on data from January – June 2017 of patients (n=300) 65 years and older in our electronic medication record (EMR) and from a Center for Disease Control (CDC) validated “Healthy Days” questionnaire administered by Meals on Wheels Inc (MOWI) of Tarrant County at a primary care geriatric clinic. The questionnaires examined physical and mental health and history of falls and hospitalizations, while the EMR provided Activities of Daily Living/Independent Activities of Daily Living (ADL/IADL) scores and demographic data. In addition to frequencies, odds ratios (OR) with 95% confidence intervals (CI) were estimated in a logistic regression analysis. Chi square tests compared groups. Results: The mean age was 77.63 years with 77% being female, and the mean number of medications per person was 11. Of those with alerts (n=210), the mean number of alerts per person was 2, with the most common being duplicate therapies (n=148) and 26% reported a fall history while 41% reported dizziness. The odds of reporting dizziness and a previous fall is 3.7 times higher compared to those without a previous fall. The odds of having a previous fall is 2.4 times higher for those reporting a lower health status (X2=8.433, df=1, p=0.004). Females had a higher proportion and were more likely to generate an alert than males (X2=5.679, df=1, p=0.017). The odds of having an alert are increased, but not statistically significant, for clients with low ADL/IADL scores and nonwhite (p=0.144, p=0.078, p=0.281). Conclusions: If patients are able to change or remove a medication predisposing them to dizziness, perhaps fall risk can be reduced. With the rising elderly population and the elderly’s increased frailty, this could be potentially life-saving. The primary care physician shortage and increasing elderly population make it more crucial than ever to improve patient health and HomeMeds is a feasible and relatively simple way to do just that.Item Incorporating Medical Students into the Development of Age Friendly Healthcare Systems through Quality Improvement Projects(2021) Murphy, Joshua; Philip, Timothy; Severance, Jennifer; Gibson, John; Hadley, LescaPurpose: The world is aging. Health systems are often not prepared for the number or complexity of geriatric patients. Caring for this vulnerable population through age-friendly health systems is imperative for our future. With the universal lack of geriatricians, family physicians primarily care for the elderly population and are therefore ideally placed to lead changes to improve the lives of geriatric patients. The Rural Osteopathic Medical Education (ROME) Program partnered with UNTHSC's Center for Geriatrics to create geriatric-focused quality improvement projects (QIPs) for medical students to complete in their family medicine clerkships. Methods: ROME students surveyed rural family physicians regarding geriatric needs in their patient population. The results were analyzed to determine patient clinical needs as well as physician educational needs. Geriatric QIPs were developed from the survey results and implemented into the clinics. Results: 100% of the students stated that they are better able to analyze, collect, and communicate data about quality improvements in practice. 100% of the students stated that they would integrate QIPs into their practices. 67% of the family physicians strongly agreed that QIPs were useful to their practice. Conclusions: Students identified best practices to address the health needs and concerns of older adults and their caregivers. The QIPs improved care for the elderly in addition to providing experience in implementing quality improvement methods that can be used in the students' future medical practices. Incorporating medical students into QIPs in family medicine clinics is valuable for the patients, students, and physicians.Item Incorporating Medical Students into the Development of Age Friendly Healthcare Systems through Quality Improvement Projects(2022) Thompson, Sadie; Miller, Cassidy; Jackson, Garrett; Hadley, Lesca; Gibson, John; Severance, JenniferPurpose: The world is aging. Health systems are often not prepared for the number or complexity of geriatric patients. Caring for this vulnerable population through age-friendly health systems is imperative for our future. With the universal lack of geriatricians, family physicians primarily care for the elderly population and are therefore ideally placed to lead changes to improve the lives of geriatric patients. The Rural Osteopathic Medical Education (ROME) Program partnered with UNTHSC's Center for Geriatrics to create geriatric-focused quality improvement projects (QIPs) for medical students to complete in their family medicine clerkships. Methods: Two cohorts of ROME students interviewed rural family physicians regarding the needs of their geriatric patient population. Students then partnered with the physician to develop geriatric QIPs which were implemented in the clinics. Following the conclusion of the projects, students were surveyed about their experience implementing geriatric QIPs during their clerkships. Results: In the first cohort, 100% of students stated that they were better able to analyze, collect, and communicate data about quality improvements in practice. 100% of students in this cohort stated that they would integrate QIPs into their practices. In the second cohort, 76% of students stated that they were better able to analyze and collect data for QIP. In this cohort, 71% of the students stated that they would actively integrate QIPs into their practices. 67% of the family physicians strongly agreed that QIPs were useful to their practice. Conclusions: Students identified best practices to address the health needs and concerns of older adults and their caregivers. The QIPs improved care for the elderly in addition to providing experience in implementing quality improvement methods that can be used in the students' future medical practices. Incorporating medical students into QIPs in family medicine clinics is valuable for the patients, students, and physicians.Item Multidisciplinary Approach towards increasing Dementia awareness: Incorporating Project ECHO and Alzheimer's Community Forum into the Social-Ecological Model(2020) Luk-Jones, Susanna; Severance, Jennifer; Griffin, Melissa; Jose, RoslinPurpose: The prevalence of Alzheimer's in the United States is anticipated to increase by three-fold over next forty years. The Social-Ecological Model could be an effective framework in designing interventions to increase dementia awareness. This study uses two different approaches that affect distinct components of the Social-Ecological Model- Project ECHO impacting individual healthcare workers, and community forums increasing the overall community awareness on dementia. Objective: To portray the Social-Ecological model as a framework combining two dissimilar interventions addressing the focal issue of dementia. Methods: The study includes data from the first cohort of Project ECHO, and two Alzheimer's community forums held at Hurst and Arlington in 2019. Participant attendance information and surveys of Project ECHO were analyzed using Excel, and qualitative data from the community forums were analyzed by thematic qualitative analysis. Results: The first cohort of Project ECHO had a total of twenty participants encompassing seven healthcare disciplines, and partaking five sessions on dementia care. At the community level, with a combined total of seventy-five participants, educative sessions on dementia helped increase overall community awareness. Prominent barriers of language, unawareness, and stigma were identified. Major suggestions included increasing translation services, creating awareness, and volunteer recruitment. Conclusions: The Social-Ecological model can be used as a framework to address complex chronic public health issues such as dementia. While Project ECHO increased provider knowledge on dementia, community forums had a three-fold impact of creating awareness, understanding community perspectives, and relaying it to the governing authorities.Item PATIENT SAFETY CULTURE IN SKILLED NURSING FACILITIES(2018-03-14) Oderberg, Jane; Severance, Jennifer; Agena, Valerie; Ross, SarahPURPOSE Skilled nursing facilities (SNF) have an increasingly frailer and more dependent patient population with a high risk of re-hospitalization from preventable adverse events. Developing a culture of safety is a core component to clinician and staff behaviors that affect safety, quality, and patient outcomes, although little is known about improving patient safety in long term care settings. With a goal of improving the safety culture and quality of care provided in SNF settings, UNTHSC Center for Geriatrics developed and implemented the evidence-based interprofessional Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) to address falls risk reduction at skilled nursing facilities in Fort Worth, Texas. METHODS We administered the Agency for Healthcare Research and Quality (AHRQ) Nursing Home Survey on Patient Safety Culture Brookdale Broadway Plaza (n=36), the Stayton (n=26) between August and October 2017. Survey results across twelve composites of patient safety culture were used to inform the development and delivery of a TeamSTEPPS Long Term Care 2.0 training series focused on falls risk reduction. The first training session delivered in October 2017 for direct care staff (n=47) provided an overview of the TeamSTEPPS model and communication tools, and an introduction to falls risk reduction in long term care settings. A second session for direct care staff (n=37) delivered in December and January provided additional training in TeamSTEPPS strategies and development of a communication tool to aid in fall risk reduction. Initial evaluation of knowledge and skills of trainees included a Likert scale survey. RESULTS Survey analysis identified that most staff believed their residents were safe in their facility (89% Brookdale,91% Stayton,82%Trinity) and they would recommend their facility to others (76% Brookdale; 80% Stayton). The lack of communication regarding residents (Brookdale 60%; Stayton 48%) was prevalent in both facilities and most direct care staff felt they were not considered members of the care team (61% Brookdale; 50% Stayton). Initial evaluation of TeamSTEPPS training showed that a majority (92-100%) were highly confident they could describe objectives related to the TeamSTEPPS program and falls awareness and prevention. As a result of the training, an action plan and communication tool was developed with input from the trainees to ensure continuity of care, improve communication, and decrease falls. Using a Plan-Do-Study-Act continuous improvement cycle, this checklist will be implemented by designated facility personnel. A post evaluation using the patient safety culture survey will be administered. CONCLUSIONS The implementation of TeamSTEPPS at SNF facilities demonstrated benefits to staff in improving their quality of care and ability to work collaboratively for the good of the patients. We anticipate that SNF will utilize TeamSTEPPS principles to develop, implement and sustain effective patient safety interventions.Item Self-Management Program for Brain Health(2021) Jose, Roslin; Kannan, Srijaa; Ross, Sarah; Quiceno, Mary; Severance, JenniferPurpose: While developing dementia may be unavoidable, various factors contribute to its onset including lifestyle choices. The purpose of this study is to implement a program supporting lifestyle changes to improve brain health and cognitive functioning with hopes of preventing or delaying dementia. Methods: Health coaching, education and targeted assessments with feedback will be used to provide a personalized approach to addressing brain health. Inclusion criteria: ≥ 18 years old without dementia or uncontrolled psychiatric illness. Participants can choose to receive health coaching through a digital tool or in-person. They will complete assessments for each of the pillars of Brain Health: Diet, Exercise, Social Engagement, Cognitive Activity, Sleep, Mindfulness & Outlook, and General Health. Demographics, motivation to change and cognitive status will also be assessed. Health coaching will last 3 months with assessments for the pillars given 3 months before starting, at the start, at the end, and 3 months after completion. We will evaluate scores for each assessment at various points in time for improvement or other trends. Results: This program is in the beginning stages of implementation. Conclusion: This self-management program intends to promote lifestyle changes that will reduce the risk of developing dementia. If individuals make improvements in the seven pillars, they can expect optimization of cognitive functioning and risk reduction for developing dementia. Clinical implications include the development of an evidence-based program for addressing risk factors for dementia with potential for preventing or delaying its onset.