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AMDA Long Term Care Medicine - 2013


B20 - To Treat or Not to Treat: How Clinical Conundrums become Opportunities for Quality Improvement


Mar 22, 2013 3:30pm ‐ Mar 22, 2013 5:00pm

Standard: $24.00

Description

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 1.5 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 management 1.5 credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

Session Description:
This session will examine how Medical Directors can reframe regulatory and other pressures to “treat” key clinical conundrums (unintended weight loss, osteoporosis in frail elders, initiation/discontinuation of antidepressants, and urinary tract infections) into an opportunity for education, evidence-based practice, quality improvement (QI) and enfranchisement of the interdisciplinary team (IDT).  To begin, a brief introduction to QI principles will serve as a framework for subsequent discussions.  Each of four experienced Medical Directors will then review the topics noted above, beginning with a short case to highlight how the issue arose in the facility.  Attention will then shift to a brief review of the evidence base to guide clinical evaluation and treatment.  Presenters will facilitate audience discussion on how Medical Directors can use QI to foster these best practices.  They will also share the QI approach they took with their IDTs and address these complicated, controversial but common clinical issues in long term care, referencing AMDA CPGs (Clinical Practice Guidelines) as appropriate.  Each segment will last approximately 15 minutes.  The session will conclude with consideration of how QI approaches in these specific contexts generalize to other issues and conundrums. 

Learning Objective(s):

  • Articulate a framework for evaluation of weight loss, osteoporosis, depression, and urinary tract infection (UTI).
  • Summarize evidence for the pros and cons of double-sided therapeutic options regarding weight loss, osteoporosis, depression, and UTI.
  • Discuss how the interdisciplinary team can enhance the approach to each of these clinical entities.
  • Examine potential quality improvement opportunities in relation to these entities. 


Speaker(s):
Daniel Bluestein, MD, MS, CMD; Irene Hamrick, MD; Sabine Maria von Preyss-Friedman, MD, CMD; Ashkan Javaheri, MD, CMD 

Disclosure(s):
None

Reference(s):
High KP, Bradley SF, Gravenstein S, et al. Infectious Diseases Society of America. Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Diseases Society of America. J Am Geriatr Soc 2009;57:375–94. Messinger-Rapport BJ, Morley JE, Thomas DR, Gammack JK. Clinical update on nursing home medicine: 2011. J Am Med Dir Assoc. 2011 Nov;12(9):615-26. Nelson JC, Devanand DP. A systematic review and meta-analysis of placebo-controlled antidepressant studies in people with depression and dementia. J Am Geriatr Soc. 2011 Apr;59(4):577-85. Thomas DR. Use of Orexigenic Medications in Geriatric Patients. .Am J Geriatr Pharmacother. 2011;9: 97–108

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