title: Implementation of an Interdisciplinary, Team-Based Complex Care Support Health Care Model at an Academic Medical Center: Impact on Health Care Utilization and Quality of Life.
abstract: BACKGROUND
  The Geriatric Resources for the Assessment and Care of Elders (GRACE) program has been shown to decrease acute care utilization and increase patient self-rated health in low-income seniors at community-based health centers.
  
  
  OBJECTIVE
  To describe adaptation of the GRACE model to include adults of all ages (named Care Support) and to evaluate the process and impact of Care Support implementation at an urban academic medical center.
  
  
  METHODS
  152 high-risk patients (≥5 ED visits or ≥2 hospitalizations in the past 12 months) enrolled from four medical clinics from 4/29/2013 to 5/31/2014.
  
  
  METHODS
  Patients received a comprehensive in-home assessment by a nurse practitioner/social worker (NP/SW) team, who then met with a larger interdisciplinary team to develop an individualized care plan. In consultation with the primary care team, standardized care protocols were activated to address relevant key issues as needed.
  
  
  RESULTS
  A process evaluation based on the Consolidated Framework for Implementation Research identified key adaptations of the original model, which included streamlining of standardized protocols, augmenting mental health interventions and performing some assessments in the clinic. A summative evaluation found a significant decline in the median number of ED visits (5.5 to 0, p = 0.015) and hospitalizations (5.5 to 0, p<0.001) 6 months before enrollment in Care Support compared to 6 months after enrollment. In addition, the percent of patients reporting better self-rated health increased from 31% at enrollment to 64% at 9 months (p = 0.002). Semi-structured interviews with Care Support team members identified patients with multiple, complex conditions; little community support; and mild anxiety as those who appeared to benefit the most from the program.
  
  
  CONCLUSIONS
  It was feasible to implement GRACE/Care Support at an academic medical center by making adaptations based on local needs. Care Support patients experienced significant reductions in acute care utilization and significant improvements in self-rated health.
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.|Tideswell at UCSF, Division of Geriatrics, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Christine
authors.initials: C
authors.lastname: Ritchie
authors.affiliation: UCSF Health, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Robin
authors.initials: R
authors.lastname: Andersen
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.|Geriatrics, Palliative and Extended Care Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America.
authors.forename: Jessica
authors.initials: J
authors.lastname: Eng
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.|Tideswell at UCSF, Division of Geriatrics, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Garrigues
authors.affiliation: UCSF Health, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Gina
authors.initials: G
authors.lastname: Intinarelli
authors.affiliation: UCSF Health, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Helen
authors.initials: H
authors.lastname: Kao
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.|Tideswell at UCSF, Division of Geriatrics, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Kawahara
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.|Tideswell at UCSF, Division of Geriatrics, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Kanan
authors.initials: K
authors.lastname: Patel
authors.affiliation: UCSF Health, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Lisa
authors.initials: L
authors.lastname: Sapiro
authors.affiliation: UCSF Health, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Anne
authors.initials: A
authors.lastname: Thibault
authors.affiliation: UCSF Health, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Erika
authors.initials: E
authors.lastname: Tunick
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.|Tideswell at UCSF, Division of Geriatrics, University of California San Francisco, San Francisco, California, United States of America.|Research Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America.
authors.forename: Deborah E
authors.initials: DE
authors.lastname: Barnes
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D058025:Interdisciplinary Studies; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D010342:Patient Acceptance of Health Care; D010348:Patient Care Team; D011203:Poverty; D057285:Precision Medicine; D015397:Program Evaluation; D011788:Quality of Life; D000068217:Social Workers