Accreditation The American Medical Directors Association (AMDA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Designation Statement: The American Medical Directors Association designates this educational activity for a maximum of 2 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
AMDCP Credit Designation: This session has been approved for a total of 2 Management credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).
Session Description: This session presents the transitional care initiatives at the University of Michigan Health System. The University of Michigan has created a subacute service program, a Transitional Care Clinic and an Inpatient Geriatric Consult Service. This program admits and manages all University Hospital discharged patients who are admitted to four local skilled nursing facilities. The goal of this program is to facilitate safe transition of the frailest hospitalized patients from the hospital to subacute care and then to home. This program has within two years been successful in decreasing hospital length of stay for patients being discharged to skilled nursing facilities and decreased the rate of return to hospitals within 30 days of the patients discharged to skilled nursing facilities. The transitional care clinic is run by the faculty of the Turner Geriatric Clinic at the University of Michigan. The goal is to provide timely geriatric physician and social work evaluation of frail elderly who are discharged from the hospital and skilled nursing facilities. Many of these patients are transitioned over to their primary physicians after one or two transitional care clinic appointments. Finally, the Geriatric Inpatient Consult Service is managed by geriatric attendings and geriatric fellows. The goal is to identify appropriate discharge plans for the hospitalized frail elderly.
Discuss how to structure a Subacute Care Service Program affiliated with a Large Tertiary care Hospital.
Explain how to Start and Run a Transitional Care Clinic that is managed by the Geritricians and Geriatric Social Workers.
Describe how to start and run an Inpatient Geriatric Consult Service.
Measure outcomes of a transitional care program.
Speakers(s): Darius K. Joshi, MD, CMD; Caroline Blaum, MD
Disclosure(s): Darius K. Joshi, MD, CMD has no disclosures to report. Caroline Blaum, MD has no disclosures to report. Rick Bluhm, JD has no disclosures to report.
References: Delirium in postacute and Long-term Care: Lyons WL. JAMDA 2006 May;7(4):254-61. The State-of-the -science: Challenges in Designing Postacute Care Payment Policy. Leighton Chan, MD, MPH: Arch Phys Med Rehabil Vol 88, nov. 2007