title: Restructuring care for older adults undergoing surgery: preliminary data from the Co-Management of Older Operative Patients En Route Across Treatment Environments (CO-OPERATE) model of care.
abstract: Surgery is common in older adults, so geriatric and surgical providers need to develop expertise in the care of older adults undergoing surgery. The Co-management of Older Operative Patients En Route Across Treatment Environments (CO-OPERATE) program is a clinical and educational collaboration between geriatrics and several surgical specialties at Veterans Affairs Health Care Connecticut. Individuals in CO-OPERATE are co-managed during the pre-, peri-, and postoperative periods. General surgery, urology, vascular surgery, orthopedics, cardiothoracic surgery and neurosurgery all participate in the program, with geriatrics expertise provided by a geriatrician, geriatric nurse practitioner and a geriatric clinical pharmacist. In the initial 3 years, there were 211 CO-OPERATE participants; 31% were evaluated preoperatively, and 62% of the individuals seen preoperatively were seen in clinic. There was a median of three recommendations per consultation. At discharge, 56% returned to the community. Individuals seen preoperatively were more likely to return to the community (63%) than those seen after surgery (50%, P = .10). Geriatrics co-management with a variety of surgical specialties is feasible and may be associated with higher rates of discharge back to the community.
authors.affiliation: Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Walke
authors.forename: Ronnie A
authors.initials: RA
authors.lastname: Rosenthal
authors.forename: Mark
authors.initials: M
authors.lastname: Trentalange
authors.forename: Melissa F
authors.initials: MF
authors.lastname: Perkal
authors.forename: Maria
authors.initials: M
authors.lastname: Maiaroto
authors.forename: Sean M
authors.initials: SM
authors.lastname: Jeffery
authors.forename: Richard A
authors.initials: RA
authors.lastname: Marottoli
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003237:Connecticut; D003299:Cooperative Behavior; D004185:Disability Evaluation; D005260:Female; D016330:Frail Elderly; D005853:Geriatrics / Q000458:organization & administration; D006785:Hospitals, University; D006787:Hospitals, Veterans; D006801:Humans; D033183:Interdisciplinary Communication; D007902:Length of Stay; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration*; D010351:Patient Discharge; D019990:Perioperative Care / Q000379:methods*; D013043:Specialties, Surgical / Q000458:organization & administration
keywords: co-management; geriatrics; model of care; surgery; surgical