summa geriatrics/media/files/pdfs/pressroom/... · 2012. 9. 21. · a su m m a he a l t h sy s t e...

A S u m m A H e A l t H S y S t e m P u b l i c A t i o n • W i n t e r 2 0 1 1

Summa Geriatrics

5

Improving Quality of Care: The Delirium Initiative

10

It’s My Health Empowers Patients to Manage Their Own Care

12

SAGE Partnership Mends Care Gaps for Dual-Eligible Patients

16

Care Coordination Network Smooths Transitions between Care Settings

22

Hospice and Palliative Medicine: The Road to Recognition

30

2011 Accomplishments

SummA HeAltH SyStem: An overview

Summa Health System is an Integrated

Healthcare Delivery System that

provides coordinated, value-based

care across the continuum for

the people and populations we serve.

We hold ourselves clinically and

financially accountable for health

outcomes in our communities.

We integrate the resources of seven

owned, affiliated and joint venture

hospitals; a regional network of

ambulatory centers, a network of more

than 1,000 physicians that includes a

250+ employed multi-specialty group,

a 150,000+ member health plan, a

System-level foundation and 10,000

employees, nurses and healthcare

professionals to provide the right care

at the right time in the right place for

our patients.

As an Integrated Healthcare Delivery

System, we are positioned to utilize the

strengths of the organization to become

a national model of excellence for other

organizations to follow.

At Summa Health

System today, you see

the healthcare system

of tomorrow.

S u m m A H e A l t H S y S t e m : A n o v e r v i e w2

SummA HeAltH SyStem’S inStitute for Senior And PoSt Acute cAre: A comPreHenSive APProAcH

educAtion

• Geriatric Medical Education• Geriatric and palliative medicine fellowships• Geriatric education for nursing and other disciplines• Provide interdisciplinary team training and support• Geriatric Concepts Nursing Orientation Program• ACE and Institute Site Visits and Consultation

reSeArcH community collAborAt ionS

• Care Coordination Network - 36 Skilled Nursing Facilities (SNF) preferred provided network

• SAGE Project: Area Agency on Aging Partnership

• Alzheimer’s Association• Akron Regional Hospital Association

• Interdisciplinary Consortium for Aging Research and Education (ICARE)

• Geriatric Mental Health Coalition• Caregiver Institute

• Center for Senior Health • Comprehensive geriatric

assessments • Geropsychiatry • Falls and Balance Clinic • Neuro-psychology • Urinary Incontinence

• Inpatient • ACE Unit • Palliative Care Unit and Consults • Stroke Unit • Geriatric Consult Service • ACE of Hearts • Geropsychiatry Unit

• Post Acute • Summa HomeCare • Summa Home Infusion • Palliative Care and

Hospice Services • SNF-Geriatric Rehabilitation

Units • Physician House Call Program • Transitional Care -

“Bridge to Home” Program

clin icAl cAre

tHe inSt itute

• Health Services Research and Education Institute (HSREI)

• Acute Care for Elders (ACE) Project• Strategies to Enhance Post-Stroke

Care and Recovery (STEPS) Trial• After Discharge Care

Management of Low Income Frail Elderly (AD LIFE) Trial*

• Elder Abuse • Promoting Effective Advance Care for

Elders (PEACE) Trial (NPCR Center)**

*Funded by grant # RO1 HS0 14537**Funded by the National Palliative Care Research Center Grants

GoAl: To improve the health, quality of care and functional status of older adults through research, education of healthcare

professionals, patients and caregivers and provision of consultative, clinical and supportive services and programs for older

adults, their caregivers and healthcare providers.

3A S u m m A H e A l t H S y S t e m P u b l i c A t i o n ● w w w . S u m m A H e A l t H . o r G

l e t t e r f r o m o u r l e A d e r S H i P t e A m

letter from our leAderSHiP teAm

Dear Colleague:

It’s been an exciting year – one filled with innovation, achievements and recognition – but also with a great deal of uncertainty and change. With healthcare reform, payment for services will be increasingly tied to achieving quality outcomes.

As an integrated healthcare delivery system, Summa Health System is well positioned to provide added value to patients, payers and the communities we serve – and to thrive, not just survive, in the post- healthcare reform era. We are pleased to share some of the highlights of the past year in this issue of Summa Geriatrics.

Inside this edition, you will learn how:

• Two hospitals reduced the substantial morbidity and mortality associated with delirium in acutely ill, hospitalized older adults.

• A medical school helps ease the critical shortage of physicians with geriatric training by partnering with Summa to implement the CRIT program.

• A new program called It’s My Health eases patients’ transition from hospital to home after discharge.

• Members of the Care Coordination Network (CCN) improve patient outcomes through effective care coordination across a range of healthcare settings.

• A unique partnership between Summa and the local Area Agency on Aging mends gaps in care for dual-eligible patients.

The valuable work of the Institute for Senior and Post Acute Care team continues, albeit without Dr. Kyle Allen at its helm. Dr. Allen leaves behind a lasting legacy at Summa – a collaborative, creative atmosphere where healthcare professionals, community resources, medical researchers and others share innovative ideas and work together to improve the quality of life for older adults in the greater Akron region. Summa Health System’s Institute for Senior and Post Acute Care continues to maintain its place of leadership in the field of geriatric medicine, with ongoing research programs and community outreach activities designed to improve care for older adults.

We look forward to sharing our ongoing journey with you. We invite you to visit our website at summahealth.org/seniors or contact us directly with any questions or comments via e-mail or by calling (330) 375-3747.

Sincerely,

Maryjo L. Cleveland, M.D. Steven Radwany, M.D., FACP, FAAHPMInterim, Chief, Division of Geriatrics Interim, Co-Medical Director, Institute for Senior and Post Acute CareInterim, Co-Medical Director, Institute for Senior and Post Acute Care Medical Director, Summa Palliative Care and Hospice ServicesMedical Director, Center for Senior Health Program Director, Palliative Medicine and Hospice [email protected] Chair, Ethics Committee [email protected]

4

imProvinG QuAlity of cAre: tHe delirium initiAtive

Delirium is defined as an acute fluctuating disturbance of consciousness, attention,

cognition and perception that affects sleep, emotion and psychomotor activity.

It is the most common complication of hospitalization and affects up to 20% of

elderly patients – with even higher rates of occurrence found in oncology, intensive

care and surgical units.

Written by: Lyn Benedict, MSN, R.N., CNS; Allison Sabo, BSN, R.N.; and Carolyn Holder, MSN, R.N., GCNS-BC

Rex Wilford, M.D. discusses specifics with a nurse regarding the delirium order set.


t H e d e l i r i u m i n i t i A t i v e

Patients who develop delirium:

• Have higher rates of morbidity

and mortality which are

comparable to that of sepsis and

myocardial infarction

• Have significantly longer length

of hospital stay

• Require significantly higher rates of post-

hospital institutionalization

Prevention of delirium in high risk groups is

by far the most effective strategy.

Studies have shown that by using non-

pharmacologic interventions, there is

more than a 33% decrease in incidence of

delirium. The tactics used to achieve this

reduction include:

• Avoiding sleep deprivation

• Enhancing mobility

• Addressing visual and

hearing impairments

• Avoiding dehydration

• Cognitive-stimulating at-risk

elderly patients

Established in 2007, the members

of the Delirium Prevention and

Treatment Quality Improvement

A Comparison of IV Lorazepam Use Pre- and Post- Implementation of Delirium Initiative on Medical/Surgical Units at Summa Akron City and St. Thomas Hospitals

A Comparison of Atypical Antipsychotic Use Pre- and Post-Implementation of Delirium Initiative on Medical/Surgical Units at Summa Akron City and St. Thomas Hospitals

A Comparison of Haloperidol Use Pre- and Post-Implementation of Delirium Initiative on Medical/Surgical Units at Summa Akron City and St. Thomas Hospitals

0

50

100

150

200

250

300

350

400

450

TOTAL Prn agitationor anxiety

One time Other ETOH w/d

423

335

301

245

200

164

130108

93

36 39 12 6 5 21

April 2009 September 2010 March 2011

0

20

40

60

80

100

120

140

160

TOTALPatients

Risperidone AripiprazoleQuetipine Olanzapine Ziprasidone

129 131

1520

83 82

21 26 2214 13 11 103 3

71

30

143


125

130

135

140

145

150

155

160

165

170

TOTAL Patients

April 2009

165

154

140

September 2010 March 2011

0

10

20

30

40

50

60

70

Loading dose >5 mg doses IV usage

1.8 5.4 3.9 0.71

21.6

28.6

63

49 49


6

Project Work Group were asked to

design and implement a delirium

protocol. An interdisciplinary team

was formed to create a protocol for

the prevention, early recognition and

treatment of delirium.

When delirium develops, the early

recognition and prompt identification of

underlying causes can often decrease

the severity and morbidity associated

with this condition.

Historically, the recognition of delirium

among healthcare workers has been

poor, with a recent study conducted

at Summa Health System’s Akron

City Hospital showing identification of

delirium by the primary care team in

only 30% of cases.

In response, the team developed an

interdisciplinary protocol, including an

evidence-based screening and treatment

process coupled with screening tools

to assist physicians and nurses in

identifying, treating and preventing

delirium in high-risk patients.

The protocol includes:

• Screening tools for nurses to

help them identify possible

high-risk patients

• An interdisciplinary plan of

care to implement non-

pharmacologic interventions

to decrease delirium risk

• A screening process to identify

patients developing delirium early

in the course of the syndrome

• An evidence-based computerized

Delirium Treatment order set

The electronic Delirium Order Set aids

physicians in conducting a prompt

work-up on the patient to discover

the underlying causes of delirium.

It includes relevant lab tests, a

medication review by a pharmacist and

the appropriate nursing orders.

If a patient identified with delirium

becomes severely agitated (at risk

to harm themselves or others) or

exhibits behavior which interferes with

their care, the delirium order set also

includes appropriate pharmacologic

management strategies.

The protocol was initially piloted on the

Acute Care for the Elderly (ACE) unit

located at Summa Akron City Hospital

in 2009 and was effective as shown by

the following results:

• The incident rate of delirium

post-protocol implementation

improved by 2.3%

• Mean days of delirium decreased

• Average length of stay

(LOS) decreased

• Cost per case decreased

• Mortality and transfer to intensive

care units (ICU) decreased

• Percentage of patients returning

home and to prior level of

care increased

• Thirty (30) day hospital and

emergency department readmission

rates decreased

• High-risk medication use

(benzodiazepines) decreased

This protocol has already been

implemented at Summa Akron City

and St. Thomas Hospitals in three

areas: medical surgical, telemetry and

rehabilitation units.

Since the expansion of the program

to two campuses, the overall metrics

utilized are LOS and cost per case.

Since this is a quality improvement

initiative, a delirium nursing-specific

audit tool was developed to provide

protocol compliance feedback to

nursing staff.

Physician reeducation sessions and

electronic medical record reports

showing the use of the computerized

order set are also a part of the success

measures. It is important to note

that these measures have indicated

increased acceptance and use

by physicians.

The momentum for this initiative

continues as Summa’s critical care

unit establishes their own program

and other system hospitals express

an interest in beginning their

own initiatives.

To date, the program reflects positive

patient outcomes, which are the primary

focus of Summa Health System as it

is our mission to provide the highest

quality, compassionate care to our

patients and members and to contribute

to a healthier community.

Please contact Lyn Benedict

at (330) 375-3716 or

[email protected]

to learn more about the

delirium protocols implemented

at Summa Health System.


delirium Project 2011 AccomPliSHmentS

Allen K, Fosnight S, Wilford R, Benedict L, Sabo A, Holder C, Jackovitz D, Germano S, Gleespen L, Baum E, Wilber S, Hazelett S. Implementation of a System-Wide Quality Improvement Project to Prevent Delirium in Hospitalized Patients. Journal of Clinical Outcomes Management; published 6/11.

Garner M, Fosnight S, Letting-Mangira D, Baum E, Wilford R, Allen K, Hazelett S, Benedict L, Hewit M. The Effect of Haloperidol Loading Dose on the Duration of Delirium. 2011 ACCP Annual Meeting, Pittsburgh, PA, October 16-19, 2011.

Benedict L. Outcomes of an Acute Delirium Detection, Prevention and Treatment Intervention Program. National Gerontological Nursing

Association (NGNA) 2011 Annual Convention, Hyatt Regency, Louisville, KY, October 13-16, 2011.

Benedict L. Outcomes of an Acute Delirium Detection, Prevention and Treatment Intervention Program. Robinson Memorial Hospital,

an affiliate of Summa Health System, Nursing Research Day, Ravenna, OH, April 29, 2011.

Deen M. The Effect of Haloperidol Loading Dose on Duration of Delirium. Great Lakes Residency Conference, Purdue University,

West Lafayette, IN, April 28, 2011.

Benedict L, Fosnight S. Components of the Delirium Initiative. Crystal Clinic Orthopedic Center: Nurse Champions, Akron, OH,

March 17, 2011.

Benedict L, Sabo A, Holder C. Delirium Panel Discussion. Advanced Medical Surgical Workshop, Summa Health System, Akron, OH,

March 3, 2011.

Pub

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t H e d e l i r i u m i n i t i A t i v e

Members of the Delirium Prevention and Treatment Quality Improvement Project Work Group.

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sBenedict L. Outcomes of an Acute Delirium Detection, Prevention and Treatment Intervention Program. National Gerontological Nursing

Association (NGNA) 2011 Annual Convention, Hyatt Regency, Louisville, KY, October 13-16, 2011.

Fosnight S, Moss K, Sabo A, Holder C, Hazelett S, Benedict L, Germano S, Allen K. The Role of Pharmacists in Delirium Prevention/Treatment in the Acute Care Setting. Inaugural Conference American Delirium Society; Indianapolis, IN, June 5-7, 2011.

Deen M, Fosnight S, Letting-Mangira D, Baum E, Wilford R, Allen K, Hazelett S, Benedict L. The Effect of Haloperidol Loading Dose on Duration of Delirium. Ohio College of Clinical Pharmacists Spring Meeting; Warrensville Heights, OH, May 23, 2011.

Scott E (NEOMED Med Student), Baum E, Benedict L, Sabo A, Apolonio F, Hazelett S, Fosnight S. Clarifying Confusion: Educational Intervention to Improve Delirium Recognition. AGS Annual Meeting, Orlando, FL, May 14, 2010.

Gossett P, Maxwell C, Hazelett S, Allen K. The Role of a Geriatric Consult Team in Improving Delirium Outcomes. AGS Annual Meeting,

Orlando, FL, May 13, 2010.

Holder C, Sabo A, Hazelett S, Benedict L, Fosnight S, Germano S, Allen K. The Sensitivity and Specificity of the Six Item Screener© in Identifying Patients at Risk for Delirium on an Acute Care for Elders Unit. AGS Annual Meeting, Orlando, FL, May 13, 2010.

Fosnight S, Moss K, Sabo A, Holder C, Hazelett S, Benedict L, Germano S, Allen K. The Role of Pharmacists in Delirium Prevention/Treatment in the Acute Care Setting. AGS Annual Meeting, Orlando, FL, May 13, 2010.

Benedict L. Outcomes of an Acute Delirium Detection, Prevention and Treatment Intervention Program. Robinson Memorial Hospital,

an affiliate of Summa Health System, Nursing Research Day, Ravenna, OH, April 29, 2011.

Sabo A, Hazelett S, Holder C, Benedict L, Fleming E, Fosnight S, Germano S, Allen K. Outcomes of an Acute Delirium Detection, Prevention and Treatment Intervention. 14th Annual Nurses Improving Care for Healthsystem Elders (NICHE) Conference, Las Vegas, NV, April 6-8, 2011.

Poster was voted 2nd place out of 78 posters presented at conference.

Holder, C. An Interdisciplinary Model for Delirium Management: Measuring Effectiveness of a Structured Interdisciplinary Process. NICHE, Hartford Institute for Geriatric Nursing, NYU. April 8, 2010.

Benedict L, MSN, R.N., CNS; Sabo A, BSN, R.N. Summa Health System Patient Safety Award

Delirium Initiative: Implementation In recognition of the outstanding contribution to patient safety. June 18, 2010.

Benedict L, MSN, R.N., CNS; Sabo A, BSN, R.N.; Allen K, D.O. Risk Management Award from American Excess Insurance (AEIX)

Dealing with Delirium: An interdisciplinary strategy for addressing the most common psychiatric syndrome in the hospital. Presented at Premier Insurance Management Services 2011 Annual Breakthroughs Conference in Nashville, TN, June 14-16, 2011.


The overall trend in healthcare today is to be more patient-centric – which means

motivating patients to take an active, primary role in their own care.

Summa Health System is on the leading edge of this endeavor – thanks to a group

of nurses at Summa Akron City and St. Thomas Hospitals.

After examining the literature –

especially in the area of

transitional coaching models –

Carolyn Holder, MSN, R.N., GCNS-BC,

Manager, Transitional Care, for

Summa Akron City Hospital, and the

members of the Transitional Care

Task Force, devised a method that

would fit into the existing hospital

structure where nurses could teach

patients to get involved in their own

care after they were discharged from

the hospital.

The result is It’s My Health, a program

developed to support patient-centered

care and improve the transition of care

between hospital and home.

It’s My Health begins with a folder

(given to a patient upon admittance)

and a process, which helps patients

understand how to take care of

themselves, and a system that helps

them keep their materials together to

share with their healthcare providers.

The folder contains a brief review of

discharge instructions, along with a

single-page checklist to make sure

patients understand and are prepared

for discharge. There is also a medication

list and reminder, several blank pages

to record questions for their doctor

and other notes, a medical history

section and an area to store healthcare

providers’ business cards.

Nurses on every shift talk with the

patients regarding key symptoms they

should look for post-discharge.

It’s My HealtH emPowerS PAtientS to mAnAGe tHeir own cAre – And booStS comPliAnce rAteS

Written by (and also pictured): Carolyn Holder, MSN, R.N., GCNS-BC and Kathy Wright, MSN, R.N., GCNS-BC., PMHCNS-BC, FGNLA

I t ’ s M y H e a l t H e m P o w e r S P A t i e n t S t o m A n A G e t H e i r o w n c A r e10

ANCC National Magnet Conference Best New Knowledge, Innovations, and Improvements Poster – It’s My Health: A nursing model combining patient centered care and transitional care

“For example, with patients with heart

failure, instead of just telling them what

to look for, we ask them, ‘Can you tell

me what symptoms you need to watch

for when you get home?’” Holder said.

The It’s My Health program also

includes a follow-up call made 24 to

48 hours post-discharge, asking patients

whether they’ve made their follow-up

appointment calls with their physicians.

If the answer to the question is “No,”

the caller makes it clear to the patient

they really need to make that crucial

phone call.

Past studies have shown that more than

one-half of patients that are readmitted

to the hospital did not follow-up with

their doctors post-discharge.

A pilot study of the It’s My Health

program was conducted on three

nursing units (4 North, 5 North and

7 West) at Summa Akron City Hospital

during the third quarter of 2010.

During the pilot, 504 patients were

discharged with 62% of follow-up

calls made to patients in their homes.

Follow-up phone calls revealed that

76% of patients in the program had

made follow-up appointments with

physicians and 78% had filled their

prescriptions.

But compliance wasn’t the only positive

impact noted during the pilot study.

Press-Ganey patient satisfaction

scores also increased from the 5th to

80th percentile range for some of the

discharge measures. For patients who

completed both a follow-up call and

the satisfaction survey, there was a

significant increase in satisfaction with

admission, discharge, nursing, personal

issues and physician care.

Results from the pilot indicated that the

“It’s My Health” care delivery model

effectively prepares patients for the

transition from hospital to home and can

be incorporated into routine care with

little difficulty.

More studies are needed to see whether

this model impacts readmission rates,

according to Holder.

The program also supports Summa

Health System’s vision of an

Accountable Care Organization (ACO),

which is expected to be implemented on

a widespread basis in 2011 at Summa

Akron City and St. Thomas Hospitals.

Several new staff positions have been

created to conduct follow-up calls

following patients’ discharge from

the hospital.

Full-scale implementation of It’s My

Health was completed in August 2011

at Summa Akron City and St. Thomas

Hospitals. The program will be rolled

out to other Summa hospitals beginning

in 2012.

For more information about the

It’s My Health program, contact

Carolyn Holder at (330) 375-7784

or [email protected].

It’s My Health Model of Care

ADMISSION INPATIENT DISCHARGE POST DISCHARGE

Nurse introduces It’s My Health

to patient.

Patient identifies goals for the

hospitalization.

Patient records their questions and notes about their treatment

plan in their It’s My Health folder.

Physician(s) give business cards to

patients to place in their It’s My Health folder

Patient is asked to take their It’s My Health folder with

them to all of their physician appointments.

Using “teach-back” methodology, nurse works with patient to

educate him/her about their condition, treatment plan, self-care tips, etc.

Nurse reviews medications and

discharge instructions with patient.

A follow-up phone call is made to the patient within 24-48 hours after their

discharge from the hospital.

Caller asks the patient:

How are you doing?

Did you make a follow-up appointment with your

Primary Care Physician?

Did you get all of your prescriptions filled?

Do you have any questions or concerns about anything that I can answer for you?


SAGe PArtnerSHiP mendS cAre GAPS for duAl-eliGible PAtientS

Written by: Kyle Allen, D.O. and Sue Hazelett, MS, BSN

Indeed, 75% of people more than

65 years old have at least one chronic

condition – and 50% have at least two,

according to the Agency for Healthcare

Research and Quality.1 Chronic illnesses

will place an increased burden on the

U.S. healthcare system since people

with chronic conditions account for

78% of all healthcare spending and

90% of all hospital costs.2

Patients who rely on Medicare and

Medicaid to pay for their healthcare

needs (dual-eligibles) present additional

challenges to both state and federal

policymakers. They account for nearly

half of Medicare spending and more

than a quarter of Medicaid spending.

Because these two funding streams

are not integrated, these patients

often experience fragmented care. A

lack of access to coordinated care can

lead to poor quality care, inadequate

management of chronic health

conditions and potentially avoidable

hospitalizations.

As currently structured, the healthcare delivery system in the U.S. is both ineffective

and unsustainable, especially regarding chronic illness care. As the population ages,

there will be a substantial increase in the number of people with chronic diseases.

Maryjo Cleveland, M.D., talks with a patient during a geriatric assessment in the Summa Center for Senior Health.

S A G e P A r t n e r S H i P m e n d S c A r e G A P S f o r d u A l - e l i G i b l e P A t i e n t S12

PurposeThe purpose is to describe the

development of a unique collaboration

between a healthcare system and

a community-based long-term care

provider whose goal was to mend

known gaps in care for dual-eligibles

by integrating the social and biomedical

models of care and coordinating the

Medicare and Medicaid funding streams

using existing resources.

BackgroundThis collaborative effort began in the

mid-1990s between two entities,

Summa Health System and the Area

Agency on Aging (AAoA) 10B, Inc.,

both located in Akron, Ohio. Summa

Health System, an integrated healthcare

delivery system with its own health

insurance plan, had adopted Wagner’s

model of chronic illness care (Wagner

et al, 1996) on several of its inpatient

units. This model emphasizes that

effective chronic illness care can only

be achieved through redesigning the

healthcare delivery system, including

the use of interdisciplinary teams.

The Center for Senior HealthAs an Integrated Healthcare Delivery

System, Summa Health System has a

vested interest in keeping its members

as healthy as possible. As a result, in

the mid-1990s, Summa Health System

expanded its use of Wagner’s model

and created the Center for Senior

Health (CSH). The CSH is an outpatient

consultative service that supports the

primary care physician (PCP) through

interdisciplinary comprehensive

geriatric assessment, high risk

assessment, a geriatrics resource

center, a clinical teaching center and

post-inpatient consultation follow-up.

The CSH is staffed by geriatricians,

nurse practitioners and social workers,

which allows the Center to integrate

the medical and social models of care

so that a more complete picture of the

patient’s strengths and needs emerges.

However, a major limitation of the

CSH was that it did not have access to

patients in their homes – nor could it

provide long-term case management

services to patients and their families.

Instead, the CSH had to rely on self-

reporting by patients when devising

its interdisciplinary care plans, which

is often unreliable. Since the home is

the place where the majority of chronic

illness care occurs, the CSH began to

rely heavily on information obtained

during home assessments made by

community-based long-term care

providers from the local Area Agency

on Aging.

The Area Agency on Aging 10B, Inc.At the same time, the Area Agency

on Aging was encountering its own

challenges with the dual-eligible

population. In addition to its other

programs, the AAoA administers

a Medicaid waiver program called

PASSPORT, which is conceptually

a social model of care delivery that

addresses the functional, social, and

psychological needs of low-income

chronically-ill older adults whose

functional status qualifies them for

nursing home placement. The primary

goal of PASSPORT is to delay or

prevent nursing home placement for

dual-eligibles.

Care managers at the AAoA found

themselves managing a growing

number of consumers with functional

deficits, geriatric syndromes and

multiple chronic illnesses.

In fact, as much as 10% of their total

consumer population fell into this

high-risk category. As a result, they

implemented a high-risk case

management program that focused on

health promotion and illness prevention.

Although this program included health

promotion, the AAoA still operated

under a social model where care

managers had limited interactions

with primary care physicians and no

access to an interdisciplinary team or

to hospital discharge planners. Care

managers also did not have extensive

knowledge about geriatric syndrome

management, medication management

or basic medical care. Without input

from medical professionals who can

manage chronic illnesses within

the home care setting, too many

consumers were dis-enrolling from

PASSPORT and being placed in nursing

facilities. Indeed, despite PASSPORT’s

explicit goal to keep individuals living

independently in their own homes,

almost half of PASSPORT consumers

were being transferred to nursing

facilities each year.

1 Agency for Healthcare Research and Quality, (2002). Chronic disease self-management program can help prevent or delay disability in patients. AHRQ.

2 Partnership for Solutions (2002). Chronic conditions: Making the case for ongoing care. Baltimore, MD: Johns Hopkins University.


The SAGE PartnershipBoth Summa Health System and AAoA

leaders realized they needed a way

to formalize and expand the

communication process that had begun

when CSH began relying on AAoA care

managers to provide information about

the patient’s home situation.

Leaders from both entities identified a

lack of continuity of care and realized

that much of the problem related

to communication problems and

fragmentation of care according to

funding streams (Medicare for medical

issues and Medicaid for social issues).

Thus, in 1995, Summa and AAoA

embarked upon the SAGE project

(Summa Health System/Area Agency

on Aging, 10B/Geriatric Evaluation

Project). SAGE provided the structure

where individuals from both entities

could come together to redesign the

care processes that were in place to

effectively integrate acute medical care

services, outpatient medical services

and the network of community-based

long term care services. Importantly,

this project was unlike other programs

that seek to integrate Medicare and

Medicaid services because there was

not an integrated funding mechanism

or contractual relationship to work

from, just a collaborative effort on

behalf of both organizations to meet

common goals.

The goal of SAGE was to provide a

coordinated healthcare delivery system

to improve linkage to community

resources and reduce fragmentation of

care to improve the health and

functional status of older adults, while

also preventing institutionalization

of those seniors who were at risk for

nursing home placement. The SAGE

project furthered the goals of all

organizations involved by offering a

“value-added” method of coordinated

comprehensive health and human

service delivery.

Operationally, the first step in this

process was to form a task force.

The SAGE task force consisted of

physicians, nurses, social workers, care

managers and administrators from both

institutions. The task force met monthly

for two years, then changed to quarterly

meetings. During those initial two years,

the task force successfully:

• Developed screening and referral

protocols for all care providers for

at-risk older adults who require

integrated care management services

• Established mechanisms for

sharing information

• Devised follow up protocols

• Identified gaps and potential

duplication in service delivery

• Stationed an AAoA case manager

at the CSH as part of the

interdisciplinary planning process

• Established a contact person at

each institution

• Educated staff

• Tracked outcomes and statistical data

• Identified and addressed barriers to

implementation of the protocols

The R.N. Assessor ProgramIn 2000, an in-hospital R.N. assessor

program was added to SAGE to address

a services lag issue. Patients were

discharged from the hospital with

skilled home care services and, after

30 to 60 days, were often referred

to PASSPORT, which caused a lag in

services until Medicaid was approved.

The R.N. assessor program bridges the

gap between acute medical care

and the community-based aging

network to maximize services without

duplication. It also helps Summa staff

transition older adults to the appropriate

care setting.

S A G e P A r t n e r S H i P m e n d S c A r e G A P S f o r d u A l - e l i G i b l e P A t i e n t S14

Outcomes from SAGE Numerous benefits were realized

by all parties as a result of the

SAGE collaboration.

Some of the benefits SAGE provided to

consumers include:

• Improvement in function

• Reduced hospitalizations

• Increased patient and caregiver

satisfaction with care

The benefits SAGE offered to the

healthcare delivery system include:

• Improved communication among

all parties involved in the patient’s

care (PCPs, hospital, AAoA) with

the establishment of direct

organizational linkages

• Decreased fragmentation of care

• Decreased costs

Both Summa Health System and

AAoA staff members offered positive

feedback about how SAGE impacted

patient care, including:

• Improved communication amongst

all participants

• Improved ability to better

serve consumers

• A better understanding of each

discipline’s internal operations

• A better understanding of the “big

picture” of healthcare delivery,

funding streams and resources

• Savings in staff time due to

streamlining communications

and tasks

Finally, the community (taxpayers,

legislators) saw benefits from SAGE in

the form of continuing participation in

the PASSPORT program and delaying

and/or eliminating costly institutional

care for older adults.

ImplementationThe SAGE project required no additional

funding or formal contractual agreements

between care providers– simply a

commitment from staff to collaborate.

The use of existing resources makes

the SAGE project relatively easy to

replicate and adapt for use in other

communities. The main barriers to

implementation, besides the technical

logistics of information-sharing between

agencies, had more to do with the

“human” side of managing change than

working through technical challenges.

The three critical barriers to

implementation are listed in the

chart above, along with suggestions

on how to mitigate risk and ensure

project success.

ConclusionToday, our healthcare agencies and

institutions see that continuing on

separate tracks is no longer in the best

interest of medicine, managed care or

community-based long term care and

certainly not in the best interest of the

consumers we share. In the years ahead,

with the projected significant growth

in the older population and the advent

of accountable care, the development

of new healthcare delivery models

designed to respond to the complex

needs of this population, such as the

SAGE project, will become a necessity.

For more information about

the SAGE project, contact

Sue Hazelett at (330) 375-3051


BARRIER MITIGATION STRATEGY

ReferencesAgency for Healthcare Research and Quality (2002). Chronic disease self-management program can help prevent or delay disability in patients. AHRQ.

Partnership for Solutions (2002). Chronic conditions: Making the case for ongoing care. Baltimore, MD: Johns Hopkins University.

Palmer R, Landefeld C, Kresevic D, et al. (1994). A medical unit for the acute care of the elderly. Journal of the American Geriatrics Society. 42: 545-552.

Wagner E, Austin B, Von Korff M. (1996). Improving Outcomes in Chronic Illness. Managed Care.4(2): 12-25.

Wagner EH, Austin BT, Von Korff M. (1996). Organizing care for patients with chronic illness. Milbank Quarterly. 74(4):511-544.

Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ. (1993). Comprehensive Geriatric Assessment: A Meta-Analysis of Controlled Trials. Lancet. 342: 1032-36.

Stewart S, Vandenbroeck A, Pearson S, Horowitz J. (1999). Prolonged beneficial effects of a home-based intervention on unplanned readmissions and mortality among patients with congestive heart failure. Archives of Internal Medicine. 159: 257-261.

Hansen F, Poulsen H, Sorensen K. (1995). A model of regular geriatric follow-up by home visits to selected patients discharged from a geriatric ward: A randomized controlled trial. Aging Clinical and Experimental Research. 7:202-6.

Leadership Select leaders who are boundary spanners.

Group Cohesiveness Take time to build trust between staff from

different agencies.

Time Commitment Convince each institution to commit staff time to the

project by helping its leadership see the value that

collaboration brings to its own bottom line.


Written by: Mike Demagall; Carolyn Holder, MSN, R.N., GCNS-BC; Nancy Istenes, D.O., CMD and Barb Berger

Led by medical director Dr. Nancy

Istenes, APN Carolyn Holder and

Mike Demagall, administrator of Bath

Manor, an Akron area long-term care

facility, the CCN includes Summa

Health System staff members and

representatives from each of the CCN

nursing facilities.

CCN representatives meet regularly to:

• Address quality measures

• Improve communication between

hospitals, acute care providers and

skilled nursing facilities

• Provide education about various

clinical topics, i.e., new care delivery

options, new guidelines, etc.

c A r e c o o r d i n A t i o n n e t w o r k S m o o t H S t r A n S i t i o n S b e t w e e n c A r e S e t t i n G S

cAre coordinAtion network SmootHS trAnSitionS between cAre SettinGS

The Care Coordination Network (CCN) is a group of skilled

nursing facilities who have agreed to work collaboratively

with Akron-based Summa Health System in order to:

• Increase communication and coordination of care for patients

• Optimize the combined expertise and knowledge of a multidisciplinary team to achieve desired clinical outcomes for patients

• Leverage combined efforts to effectively manage healthcare resources

Dr. Preeti Betkerur, nurse practitioner Scott Spillan and Bath Manor Administrator Mike Demagall discuss patients and their progress/care at Bath Manor, a skilled nursing facility in Copley, Ohio.

16

• Collaborate on developing measures

to improve patient care

Meeting participants include

representatives from many disciplines,

including:

• Advanced practice nurses

• Nursing quality coordinators

• Home care staff

• Hospice nurses

• Social workers

• Physical and occupational therapists

• Geriatricians

• Palliative care physicians

Other meeting participants may include

staff from Summa Health System

and from the nursing facilities, i.e.,

nursing directors, Minimum Data

Set (MDS) nurses, admissions

representatives, therapists and others,

as the need arises.

One of the first issues tackled by the

CCN team was the lack/quality of

information about patients who were

being transferred from acute care to a

nursing facility.

Pertinent data required for the MDS

assessment was often missing, which

required follow-up by nursing facility

staff. An MDS assessment is required

for all patients at any facility receiving

reimbursement from Medicare or

Medicaid for patient care.

Through the collaborative work of

the CCN, several contributing factors

were identified as root causes of this

problem, including:

• A lack of knowledge about the

information required for completing

an MDS assessment on the part of

the acute care staff

• Nursing facilities were asking for

patients’ charts to be copied as a

prerequisite for the referral, which

was very time-consuming

• The delay in obtaining a referral often

resulted in significant lag-time in

the identification of post acute

bed availability

The CCN committee developed a

nursing facility transfer form with input

from acute care nurses, social workers

and nursing facility members.

The form contained core information

needed by the nursing facilities to make

a decision about whether they could

effectively manage the patient.

This referral form was put into an

Internet-based information system,

which allowed rapid referrals and

expedited feedback from multiple

facilities concerning bed availability.

In acute care, patient care coordinators

and social workers were trained how to

use the system and input information

into the referral form.

The benefits of using the improved

online referral process included:

• The nursing facilities received the

information they needed

• The amount of information faxed to

the nursing facilities by the acute

care staff was reduced

• The entire process of transfer was

streamlined which decreased acute

care and extended care facility staff’s

transfer processing time

Due to the excellent results, the

network has been very well received

and participation in the network has

grown from 26 member facilities in

2002 to 39 participating facilities

in 2011.

The collaborative efforts of the Care

Coordination Network haven’t

gone unrecognized within the greater

Akron community.

In 2004, a continuum of care task force

was created by the Akron Regional

Hospital Association, with the goal

of creating a nursing facility transfer

form which could be used by all

16 member hospitals.

Members of the Care Coordination

Network participated in this effort

to streamline the transfer process, as

well as nurse case managers

from many competing hospitals

and healthcare systems.

Team members from the Care Coordination Network.


271

8

71

71

76

77

76

7780

480

80

SUMMITPORTAGE

MEDINA

WAYNE

STARKHospital locations

Care CoordinationNetwork locations

Summa Akron City Hospital

Summa St. Thomas Hospital

36 Care Coordination Network Locations in 5 Northeast Ohio Counties


The form was finalized and

implemented in 2005.

This committee has continued to work

on other quality of care initiatives,

including some which were initiated by

the CCN.

One initiative focused specifically on

the information required by emergency

departments that must be gathered

from the nursing facilities. This resulted

in the design and development of the

Post Acute Care to ED/Hospital form,

which is now in use by all area

nursing facilities.

A Care Coordination Skilled Nursing

Facility Data Trend report was created

by Dr. Kyle Allen and Don Jackovitz,

Director of Quality and Resource

Management, to provide blinded

facility-specific performance data for

the network members on a semi-annual

basis. Some of the data that is included

in the report follows:

• The number of discharges to a

nursing facility

• A facility’s 31-day readmit rate

• Mortality rates

• Average lengths of stay

• Case mix indexes

The report allows facilities to track

quality improvement over time and also

enables comparison to the group for

benchmarking purposes.

The Care Coordination Network has

continued to work to improve the

process for transferring patients

between hospital and nursing facilities

through regular reviews of cases

where patients were readmitted within

seven days and/or were deemed

poor transfers. Poor transfer cases are

forwarded to Quality Improvement

for detailed review regarding nursing

and medical issues. These cases

are then addressed through a peer

review process.

One crucial segment in the process

of providing a continuum of care for

older adult patients is the Geriatric

Rehabilitation Program, which eases

the transition from hospital to home for

patients and their families.

18

Average Length of Stay in Community Hospitals 1989 – 2009

The elderly account for a disproportionate share of hospitalizations. For example, while

individuals age 65 and older comprise about 12% of the U.S. population, they account for

approximately 35% of all hospital stays. Although advances in medical technology have

allowed the average hospital length of stay (LOS) to decrease from 7.2 days in 1989 to

5.4 days in 2009, often patients are not fully recovered at the time of their hospital discharge.1

As a result, many patients still need close management of their medical condition(s), along

with frequent medication adjustments and increased assistance with Activities of Daily Living

(ADL), such as bathing, dressing and toileting.

Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2009, for community hospitals.

089 90 91 92 93 94 95 96 97 98

YEAR

DAY

S

99 00 01 02 03 04 05 06 07 08 09

7.2 7.2 7.2 7.1 7.06.7 6.5

6.2 6.1 6.0 5.9 5.8 5.7 5.7 5.7 5.6 5.6 5.6 5.5 5.5 5.4

1

2

3

4

5

6

7

8

555 65 75 778

6 7

Geriatric Rehabilitation

is a program of skilled

rehabilitation that

incorporates specialized and

coordinated interdisciplinary

care designed to allow

patients to return home

sooner and with more

independence when

compared to a traditional

skilled rehabilitation facility.

How does the Geriatric Rehabilitation Program work?

A Summa Health System geriatrician

works with a geriatric-trained nurse

practitioner to provide the patient’s

medical care along with the facility

staff who is educated on geriatric

syndromes and medical conditions that

commonly affect older adults. They work

collaboratively with the patient and his/her

family to establish discharge goals and a

comprehensive discharge plan.

The discharge plan often includes skilled

homecare and other services that are

appropriate. Patients’ lengths of stay (LOS)

at the geriatric rehabilitation facility are

often shorter than those at a traditional

GeriAtric reHAbilitAtion ProGrAm offerS fASter recovery for older AdultS



skilled nursing facility due to the high

level of coordinated care that patients

receive at a geriatric rehabilitation

facility. As a result, a higher percentage

of patients are able to return to

community living.

One key component of the geriatric

rehabilitation unit is the weekly

interdisciplinary team meeting.

During the meeting, team members

offer their perspectives on each

patient’s needs according to insights

garnered from their respective

disciplines. Out of this collaborative

discussion, an effective discharge plan

is crafted that meets each patient’s

specific needs. The end result is

a better outcome for patients and

their families.

Members of an interdisciplinary team

typically include a/an:

• Physician (geriatrician)

• Nurse practitioner

• Dietitian

• Activities director

• Therapy director

• Insurance company representative

• Patient case manager at the facility

Decisions regarding date of discharge

and the services that need to

be coordinated are implemented at

these meetings.

Weekly team meetings allow ample

opportunity for staff to discuss each

patient’s care requirements soon

after their admission to the facility.

Early discussion of patients’ needs

leads to improved discharge planning

for each patient.

Another advantage of interdisciplinary

cooperation and communication is

improved coordination of care and the

Summa nurse practitioner Scott Spillan discusses concerns about his patient’s chronic conditions.

20

receipt of valued input from all team

members from the perspective of their

area of expertise. This keeps the team

focused on common goals and how

each discipline supports these goals.

The inclusion of an insurance

representative on the team improves

communication and encourages shared

decision-making regarding the patient’s

discharge date.

Meetings are facilitated by the nurse

practitioner, who plays a lead role

in the discharge process. Nurse

practitioners coordinate all services

and help maintain the correct balance

of the medical, social and community

resources required to best meet

patients’ needs.

By using the interdisciplinary team

approach, the team can develop

a comprehensive plan of care

for patients. This translates

to obvious benefits for patients,

families and healthcare insurance

providers, including:

• Decreased lengths of stay

• Better outcomes

• Prevention of disabilities

• Recovery of function during the

rehabilitation stay

• Cost savings

In 2005, SummaCare, the Akron, Ohio-

based health insurance provider which

is part of Summa Health Network,

adopted the Geriatric Rehabilitation

Program as their preferred care

model for the delivery of Skilled Nursing

Services. SummaCare worked closely

with Summa Health System’s geriatric

services department to implement this

specialized model of care in three

contracted skilled nursing facilities.

As the collaborative effort grew, so did

the partnerships that were added to the

interdisciplinary team.

The interdisciplinary team in 2005

included not only medical providers

and facility staff, but also added

representatives from:

• SummaCare’s case

management program

• Summa Health System’s

HomeCare program

• Summa’s Palliative Care and Hospice

Services program

• Akron’s Area Agency on Aging

By 2007, the program was expanded to

include transitional care and a patient

home visit performed by a geriatric-

trained nurse practitioner provided

within 72 hours of a patient’s discharge

from a skilled nursing facility.

For more information about the Care

Coordination Network or Summa’s

Geriatric Rehabilitation Program,

e-mail [email protected].

By 2010, SummaCare membership had grown – with an increased patient population

who reside in the four counties contiguous to Summit County, Ohio (Medina,

Portage, Stark and Wayne counties). A modified geriatric rehabilitation program was

developed to provide increased access to geriatric rehabilitation for patients living in

these outlying counties.

SummaCare contracted with regional Skilled Nursing Facilities and physicians who

worked with Summa geriatric nurse practitioners and SummaCare case managers

to increase the efficiency of care delivery and discharge planning. These patients

also receive a post-discharge transitional care visit.

The combined geriatric rehabilitation programs include care which is delivered in

seven nursing facilities across five counties with interdisciplinary and interagency

collaboration for the effective medical and social management of patients’ care and

discharge needs.


H o S P i c e A n d P A l l i A t i v e m e d i c i n e : t H e r o A d t o r e c o G n i t i o n

HoSPice And PAlliAtive medicine: tHe roAd to recoGnition

The Aging of America and the Rising Need for Palliative and End of Life Care

Written by: Steven Radwany, M.D., FACP, FAAHPM

Hallie Mason, MSN, CRNP checks in on a patient in the Acute Palliative Care Unit.

Current estimates suggest the

demand for certified palliative

medicine and hospice physicians

will exceed supply by over 6,000

physicians within 10 years. While

over 2,000 hospital-based palliative

care programs exist across the U.S.,

few hospitals have the depth or

breadth of Summa’s Palliative Care

and Hospice Services.

Summa offers a full range of

palliative care services to our

community including:

• palliative care consult service

at five system hospitals, five

nursing homes and an outpatient

cancer center,

• a palliative care clinic,

• an inpatient palliative care unit and

• a large hospice program

Summa’s palliative medicine

fellowship and research arm aim to

develop and train future professionals

in this important and growing field.

By December 2011, Summa’s

Palliative Care and Hospice Services

will have nine certified physicians,

which positions our program to meet

the growing demands throughout

Northeast Ohio.

22

For most of human history, life has been short. Life expectancy in the U.S. in 1900 was just 50 years of age – in 1995, a woman could expect to reach age 79, while her husband might live to age 73.

As a result of these changes in mortality rates, people aged 65 and above are now a much larger proportion of the American population. In 1994, this age group accounted for about one in eight persons (13%) of the population; in 2030, when the majority of baby boomers have entered old age, one in five people (20% of Americans) will be in this group.

Americans are living longer, but with more chronic illnesses that require management by skilled physicians. Demographic changes and the rise of the hospice movement across the U.S. have created an awareness of the increased need for both specialist and generalist physicians who can provide effective palliative and end of life care.

The Road to RecognitionThe American Board of Hospice and Palliative Medicine (ABHPM) was formed in 1995 by the American Academy of Hospice and Palliative Medicine (AAHPM) as an independent certifying body for those seeking to have high-level competency in hospice and palliative medicine recognized as a medical specialty.

To obtain formal recognition as a specialty by the American Board of Medical Specialties (ABMS) and the Accreditation Council for Graduate Medical Education (ACGME), certain criteria must be met, including:

• A distinct body of medical knowledge exists in the field

• There is a body of practicing physicians with defined professional roles in patient care

• Formal training is available in the specialty

• The field has a thriving professional society

Why Seek Recognition?Formal recognition as a specialty by the American Board of Medical Specialties and the Accreditation Council for Graduate Medical Education helps define and sustain a medical discipline by creating practice standards and defined competencies within a specific domain of knowledge and practice.

It encourages professionalism and is recognized by governmental bodies and the public as an area of medical practice.

The objective of the ABHPM is to create a specialty whose members can:

• Provide expert consultation and role models for colleagues, students and other healthcare professionals

• Supply educational leadership and resources for evidence-based, useful undergraduate, graduate and continuing medical education

• Organize and conduct biomedical, clinical, behavioral and health services research

• Define the hospice and palliative care model to include prevention and relief of symptoms in order to lessen pain and suffering at the end of life, as well as stressing interdisciplinary, comprehensive and continuing care of patients and those close to them

Supporters felt that formal recognition as a subspecialty would:

• Improve patient care• Create and distribute new knowledge• Establish credibility and recognition of

the discipline• Develop an infrastructure to provide

support for training and research• Increase funding for training,

research and clinical practice • Encourage payers (government and

private health insurance providers) to reimburse for clinical care related to the specialty

Defining Primary and Secondary Palliative CareIt was widely believed that any physician caring for patients with serious or life-threatening illnesses should have some basic training and skill in primary palliative care, such as the ability to:

• Manage pain and other symptoms• Assess psychosocial distress• Communicate about what to expect

during a chronic or progressive illness

A small number of specialist physicians reach a higher level of competency in secondary palliative care, where, in addition to skill in the basic competencies listed above, they also:

• Practice within interdisciplinary teams• Manage complex cases with multiple

chronic illnesses• Coordinate care across several

treatment settings• Provide assistance and support

to caregivers • Manage the needs associated with

imminent death


• Train other healthcare professionals in hospice and palliative medicine

• Conduct research to add to the body of knowledge about chronic and terminal illness

Certification and AccreditationBoth the certification of physicians and the accreditation of training programs are crucial milestones in the creation and development of any new medical specialty.

In 1996, the ABHPM created a certifying exam with eligibility criteria with two tracks to achieve certification: a post-fellowship track and an experiential track. The ABHPM certification process enjoyed wide acceptance by those in the field and there were 2,883 physicians certified during the period 1996 to 2006.

One important part of ABHPM’s strategy was their decision to accept candidates from all primary specialties rather than limiting eligibility to just one or two specialties. This deliberate choice resulted in broad-based support for the new specialty, along with an increased breadth and depth of its knowledge

base. It also allowed palliative services to be utilized in a much wider array of treatment settings. Palliative care has grown tremendously as a discipline with over 2,000 hospital-based palliative programs in the U.S.

The ABHPM also implemented a recertification process in 2004. Between 2004 and 2006, more than 300 physicians were recertified in hospice and palliative medicine.

In both the initial and recertification processes, the ABHPM made a conscious decision to mirror the procedures used by ABMS member boards. This choice proved to be an effective strategy that helped pave the way for eventual application to the ABMS.

Applications were prepared and submitted by ABHPM to both ABMS and ACGME stating that the field of hospice and palliative medicine met the criteria established for the recognition of a new medical specialty.

In June 2006, ACGME accepted hospice and palliative medicine and agreed to provide accreditation for its fellowship programs.

In October 2006, ABMS announced its approval of hospice and palliative medicine as a subspecialty.

One key item is the unprecedented level of interest from member specialties in sponsoring the new subspecialty.

As a result, hospice and palliative medicine is now a formal subspecialty of 11 underlying medical specialties, including: anesthesiology, emergency medicine, family medicine, internal medicine, neurology, obstetrics and gynecology, pediatrics, physical medicine and rehabilitation, psychiatry, radiation oncology and surgery.

In 2008, the first ABMS certification exam was held, with 1,200 physicians passing the exam. Also submitted in June 2008 was the first round of program accreditation applications to ACGME.

In January 2009, 48 hospice and palliative medicine training programs achieved ACGME accreditation, including Summa’s Palliative Medicine fellowship.

At Summa Health System, 100% of our palliative medicine physicians have received this certification. And 34% of our nursing staff – inpatient, home setting and extended care facilities have received certification.


the certification process,

contact Steven Radwany, M.D.

at (330) 379-5100 or

[email protected].

H o S P i c e A n d P A l l i A t i v e m e d i c i n e : t H e r o A d t o r e c o G n i t i o n

ReferencesInstitute of Medicine. Field MJ, Cassel CK (Eds). Approaching Death:

improving care at the end of life. Washington, D.C., USA: National

Academy Press, 1997.

Lupu Dale, Moga Dorothy N, Portenoy Russell, Radwany Steven,

Hospice and palliative medicine in the USA: the road to recognition.

European Journal of Palliative Care, 2009; 16(3).

In the picture (l to r) front row: Avon Mehaffey, R.N.; R. Daniel Cerasco, M.D.; back row: Melissa Soltis, M.D.; Cathy Bishop, R.N. have received additional certification in palliative and hospice medicine through their respective certifying agencies.

24

educAtinG future GeriAtriciAnSGERIATRIC MEDICINE FELLOW YOLEETAH RICHARDS-ILODI M.D.

Written by: Aileen Jencius, MLIS, Geriatric/Palliative Medicine Fellowship Coordinator


For a time, Richards-Ilodi worked both as

a waitress and a bartender to help pay

expenses. While still a young mother, she

decided to pursue what seemed like an

unrealistic goal: a career in medicine.

She cites strong mentoring during

medical school as the reason why she

chose internal medicine as her specialty.

Richards-Ilodi noticed significant changes

in patients as a result of simple treatments

for high blood pressure and diabetes.

When it was time to choose a residency,

Richards-Ilodi had already settled on

a large academic health system in

northeastern Ohio.

But after a single meeting with Dr. Dave

Sweet, program director of the internal

medicine residency program at Summa

Health System, she realized that Summa

was the place she wanted to be.

Impressed with Sweet’s genuine concern

for his residents, his kindness was the

deciding factor in her decision to join the

Summa “family.”

And Richards-Ilodi has never looked back.

She completed her internal medicine

residency at Summa Health System

in 2011.

Her subsequent decision to pursue

a fellowship in geriatric medicine at

Summa was simply the next logical

career step. Aware of the impact that

retiring baby boomers will have on the

U.S. healthcare system, Richards-Ilodi

wanted to be well-prepared to care for

the tidal wave of aging boomers.

Being a busy resident hasn’t stopped

Richards-Ilodi from getting involved in the

local Akron community.

One project that captured her interest is

the community garden she implemented

to encourage healthy exercise and eating

habits in her patients.

Why a Garden?Obesity exacerbates many chronic

conditions in the patients she sees every

day at the Internal Medicine Clinic at

Summa Akron City Hospital. Knowing that

nutrition and exercise are vital to good

health, Richards-Ilodi began to encourage

her patients to make positive changes

in their health by starting with small,

easy steps.

She began with helping patients learn

more about nutrition – and how to shop

for healthier foods.

Richards-Ilodi scheduled clinic

appointments in which she would read

labels on cereal boxes with patients to

teach them how to be nutrition-savvy

consumers. She filled balloons with

sand and asked patients to hold them to

illustrate the difference losing five pounds

could make in their mobility.

When she realized that many of her

patients lived in areas not suitable for

solo exercise, Richards-Ilodi encouraged

them to walk in groups.

The end result? Patients were moving again.

She celebrates each victory, too, like the

walker who lost 20 pounds – and the older

adult whose entire family now joins her on

her walks. The exercise has reduced her

dependence on a wheelchair.

The passion Dr. Yoleetah Richards-Ilodi has for improving the

health of at-risk, older adults is almost as infectious as her smile.

Richards-Ilodi is Summa Health System’s current fellow in geriatric

medicine. She has a history of working with older adults – and a

strong belief in the importance of community involvement. As a

teen, she worked in a nursing home because she enjoyed working

with geriatric patients. Her path to a career in medicine has had

its twists and turns, however.

And it hasn’t always been easy.

e d u c A t i n G f u t u r e G e r i A t r i c i A n S26

But Richards-Ilodi acknowledges that

long-term changes in her patients’

lifestyle and nutritional habits will take

time and require a broader approach.

Recognizing that sound nutrition and

exercise are important components of

good health, she began investigating

the possibility of creating a community

garden. The opportunity to share the

work and the harvest would benefit

participants in a number of ways.

The Center for Disease Control and

Prevention in Atlanta supplied the

evidence base for the project. Numerous

case studies have documented the

benefits that gardening offers both to

communities and individuals. Improving

access to healthy foods, fostering

community involvement, encouraging

social relationships and providing the

opportunity for regular exercise in a safe,

supportive environment are just some

of the positive outcomes of community

garden projects.

Richards-Ilodi had the idea and the

passion for the garden – but she still

needed land!

She approached the Summa Foundation

in 2010 for assistance in obtaining

plots for a pilot gardening project. The

Foundation gave its support, and the

garden project was a success!

Currently, Richards-Ilodi is scouting

for a new larger location for the garden

in 2012.

In the meantime, she continues to

encourage her patients to make healthy

changes in their lives. She hopes the

community garden is just the beginning.


our accredited fellowship

programs, contact Aileen Jenicus

at (330) 375-7436 or

[email protected].


CRIT Program Reduces Impact of ‘Silver Tsunami’ on U.S. Healthcare

By 2030, the number of adults age 65

and older will almost double to

70 million. Americans are not only

living longer – they’re living longer with

multiple chronic illnesses.

In fact, according to the American

Geriatrics Society (AGS), about 20%

of the Medicare population has at

least five chronic conditions, i.e.,

hypertension, diabetes, arthritis, etc.

An untold number also suffer from

geriatric syndromes often associated

with the aging process such as

incontinence, frequent falls, memory

problems and side effects caused by

taking multiple medications.

Caring for these patients is often

complicated, expensive – and requires

special training in geriatric medicine.

Unfortunately, a shortage of

geriatricians already exists in the

U.S. and is expected to worsen over

the next 20 years. Currently, there

is one geriatrician for every 5,000

adults age 65 and older. In 2030, it is

estimated that this ratio will be only one

geriatrician for every 7,665 older adults,

representing a 50% decline over the

next 25 years.

According to the American Geriatrics

Society, fewer than 320 physicians

entered geriatric medicine fellowship

training from 2004 to 2008.

Happening just as the first wave

of the “silver tsunami” of boomers

reaches retirement age, the shortage

of geriatricians is forcing medical

educators to develop new strategies

for educating the next generation

of physicians to meet the

healthcare needs of this growing

(and graying) population.

In July 2011, The Association of

Directors of Geriatric Academic

Programs (ADGAP), in partnership with

Boston Medical Center (BMC), was

awarded a $600,000 grant from the

crit ProGrAm PrePAreS tomorrow’S doctorS to cAre for A GrAyinG AmericA

Written by: Natalie Kayani, M.D. and Barb Palmisano, MA

SummaCare Physician House Calls nurse practitioner Amanda Harran provides monthly care to a House Calls patient.

c r i t P r o G r A m P r e P A r e S t o m o r r o w ’ S d o c t o r S t o c A r e f o r A G r A y i n G A m e r i c A28

Hearst Foundations to support the Chief

Resident Immersion Training in the

Care of Older Adults (CRIT) program.

This is the first year of a potential four-

year $2.2 million project that will be

evaluated annually, with the possibility

of renewed funding.

Recognizing America’s growing need

for physicians who have both

the training and clinical experience

required to effectively treat older

patients, Northeast Ohio Medical

University (NEOMED) was one of four

U.S. medical schools selected to

offer geriatric training to all medical

and surgical residency programs

within the NEOMED consortium.

The three goals of the CRIT program

are to:

• Provide geriatrics training to chief

residents in a variety of medical and

surgical specialties through intensive

educational retreats and mentored

year-long projects

• Foster institutional collaboration

across specialties and healthcare

disciplines to improve the

coordination and quality of care for

hospitalized older adults

• Enhance the teaching and leadership

skills of chief residents

Chief residents are the target group for

this educational intervention because

they play key teaching, patient care and

communications roles in their hospitals.

The CRIT program is based on a

train-the-trainer model. Senior faculty

from medical centers, selected through

a peer-reviewed application process,

attend an annual chief resident

geriatrics training retreat held by BMC

to learn how to plan and facilitate CRIT

retreats at their own institutions.

Then, with a grant issued to each

participating institution, these senior

faculty members and their CRIT project

teams conduct retreats for incoming

chief residents. Following the retreat,

participating chief residents, under the

guidance of faculty mentors, develop

and implement year-long patient care

or education projects designed to

improve the care of older patients at

their hospitals.

Summa Health System physicians

have partnered with NEOMED’s

Office of Geriatrics to implement

the CRIT program.

The NEOMED team includes Anthony

Costa, M.D., principal investigator, and

team members George Litman, M.D.,

Barbara Palmisano, MA and Margaret

Sanders, MA, LSW.

The Summa Health System team

consists of Natalie Kayani, M.D.,

co-principal investigator, along with

team members Elizabeth Baum, M.D.,

Maryjo Cleveland, M.D., Aileen Jencius,

MLIS, John Kasper Jr., M.D., Timothy

Lewis, M.D., Steven Radwany, M.D.

and Scott Wilber, M.D. Team members

serve on the project’s steering

committee and as faculty mentors to

chief residents.

The first educational retreat is

scheduled June 1-3, 2012, at Sawmill

Creek Resort in Huron, Ohio. Residents

and program directors will attend

the event at no cost, thanks to the

financial support provided by

the Hearst Foundations.

Northeast Ohio Medical UniversityNortheast Ohio Medical University

(NEOMED) formerly known as

Northeastern Ohio Universities

Colleges of Medicine and Pharmacy

is a community-based, public medical

university with a mission to improve

the quality of healthcare in Northeast

Ohio working in collaboration with

its educational and clinical partners.

With a focus on scientific and medical

research, and the interprofessional

training of health professionals that is

unique to the state of Ohio, NEOMED

offers a doctor of medicine (M.D.)

and a doctor of pharmacy (Pharm.D.)

degree, in addition to graduate-level

coursework and research opportunities

leading to master’s and doctoral

degrees in other medical areas.

NEOMED also is a founding member of

the Austen BioInnovation Institute

in Akron. For more information, visit

www.neoucom.edu.


the CRIT program, contact

Natalie Kayani at (330) 375-3800


ResourcesAmerican Geriatrics Society: http://www.americangeriatrics.org/

about_us/who_we_are/faq_fact_sheet/.

American Geriatrics Society, Fact Sheet, Ibid.

American Geriatrics Society, Association of Directors Geriatrics

Workforce Policy Studies Center. Table 3.2. Geriatric Medicine

Fellowship Programs, Family Medicine and Internal Medicine 1991/92

to 2009/10 [on-line]. Available at http://www.ADGAPStudy.uc.edu

Accessed November 21, 2010.


2011 AccomPliSHmentS

Allen K, Hazelett S, Jarjoura D, Wright K, Fosnight S, Kropp D, Hua K. The After Discharge Care Management of Low Income Frail Elderly (AD-LIFE)

Randomized Trial: Theoretical Framework and Study Design. Population Health Management. 14(3): 137-142, June 2011.

Allen K, Fosnight S, Wilford R, Benedict L, Sabo A, Holder C, Jackovitz D, Germano S, Gleespen L, Baum E, Wilber S, Hazelett S. Implementation of a

System-Wide Quality Improvement Project to Prevent Delirium in Hospitalized Patients. Journal of Clinical Outcomes Management.

Gayomali C, Radwany S, Albanese T, Mason H. Characteristics and Outcomes of Renal Patients Referred to Palliative Care in a U.S. hospital. European

Journal of Palliative Care, 18(5): 228-234, 2011.

Allen K, Ferguson S, Holder C, Hazelett S. Comprehensive Care Coordination: Interdisciplinary Care of Chronically Ill Adults.

Authored/edited by Cheryl Schraeder and Paul Shelton, to be published by John Wiley & Sons, Inc. Comprehensive Care Coordination.

Radwany S, Stovsky E, Frate D, Dieter K, Friebert S, Palmisano B, Sanders M. A Four Year Integrated Curriculum in Palliative Care

for Medical Undergraduates. American Journal of Hospice & Palliative Medicine.

Allen K, Hazelett S, Radwany S, Ertle D, Fosnight S, Moore P. The Promoting Effective Advance Care Planning for Elders (PEACE) Randomized

Pilot Study: Theoretical Framework and Study Design. Population Health Management.

Hannan J, Radwany S, Albanese T. In-hospital Mortality in Patients Over 60 with Very Low Albumin Levels. Journal of Pain and

Symptom Management.

Moeller, JR, Albanese T, Radwany S, Garchar K, Aultman J and Frate D. Functions and Outcomes of a Clinical Medical Ethics Committee:

A Review of 100 Consults. HEC Forum.

von Gruenigen V, Radwany S. End of Life and Palliative Care for Patients with Ovarian Cancer. Clinical Obstetrics and Gynecology.

Ma

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150

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April 2009

September 2010

March 2011

2 0 1 1 A c c o m P l i S H m e n t S30

Scott D, Allen K, Jarjoura D, Hazelett S, Fosnight S, Achmoody D. Comparative Effectiveness of Two Community Based Diabetes Management Approaches. Opportunity Parish Ecumenical Neighborhood Ministries (OPEN M) from National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (±$520,000) (pending final approval).

Kayani N. Chief Resident Immersion Training (CRIT) in the Care of Older Adults. Hearst Foundation. ($1,500).

Principal Investigator: Clare L. Stacey Research team: Manacy Pai, Steven Radwany, Terry Albanese. Seeking Cure and Comfort: How Race Shapes Patient Use of Palliative Care in Hospitals. Funded by the National Science Foundation and the American Sociological Association ($7,000) 2010-present.

Principal Investigator: Kyle Allen. Research and design team: Maria Pappas, Steven Radwany, Sue Hazelett, Terry Albanese, Denise Ertle, Sue Fosnight, Pam Moore, Lori Flesher, Barbara Palmisano and Patti Purcell. Palliative Care Educational Grant. This grant was used to make palliative care educational videos and other educational products for use by Area Agencies on Aging state-wide. Funding received by the FirstMerit Foundation: May 2010-May 2011.

Gr

an

ts

Fosnight S, Moss K, Sabo A, Holder C, Hazelett S, Benedict L, Germano S, Allen K. The Role of Pharmacists in Delirium Prevention/Treatment in the Acute Care Setting. Inaugural Conference American Delirium Society, Indianapolis, IN, June 5-7, 2011.

Deen M, Fosnight S, Letting-Mangira D, Baum E, Wilford R, Allen K, Hazelett S, Benedict L. The Effect of Haloperidol Loading Dose on Duration of Delirium. Ohio College of Clinical Pharmacists Spring Meeting, Warrensville Heights, OH, May 23, 2011.

Williams N, Baum E, Betkerur P, Lathia A, Hazelett S. Retrospective Pilot Study to Validate a Readmission Risk Screening Tool. 2011 AGS Annual Meeting, National Harbor, MD, May 13, 2011.

Benedict L. Outcomes of an Acute Delirium Detection, Prevention and Treatment Intervention Program. Summa Affiliate Robinson Memorial Hospital Nursing Research Day, Ravenna, OH, April 29, 2011.

Sabo A, Hazelett S, Holder C, Benedict L, Fleming E, Fosnight S, Germano S, Allen K. Outcomes of an Acute Delirium Detection, Prevention and Treatment Intervention. 14th Annual Nurses Improving Care for Healthsystem Elders (NICHE) Conference. Las Vegas, NV, April 6-8, 2011. Poster was voted 2nd place out of 78 posters presented at conference.

Snyder S, Albanese T, Allen K, Radwany S. Perceived Factors Limiting Referrals to Palliative Care and Hospice. ACOFP 48th Annual Convention & Scientific Seminars. San Antonio, TX, March 17-20, 2011.

Snyder S, Hazelett S, Allen K, Radwany S. Physician Knowledge, Utilization, and Attitude Regarding Advance Care Planning, Hospice, and Palliative Care: Much Work Remains. AAHPM annual meeting, Vancouver, Canada, February 16-19, 2011.

Benedict, L, Sabo, A. Risk Management Award from American Excess Insurance (AEIX). Dealing with Delirium: An interdisciplinary strategy for addressing the most common psychiatric syndrome in the hospital. Presented at Premier Insurance Management Services 2011 Annual Breakthroughs Conference in Nashville, Tennessee, June 14-16, 2011.

Allen, K, Holder, C. Agency for Healthcare Research and Quality (AHRQ) Innovations Exchange Profile. Cooperative Network Improves Patient Transitions Between Hospitals and Skilled Nursing Facilities, Reducing Readmissions and Length of Hospital Stays has been selected to appear in the 2010 National Healthcare Quality Report (NHRQ) and National Healthcare Disparities Report (NHDR), which documents current trends in effectiveness of care, patient safety, timeliness of care, patient centeredness, and efficiency of care. Report to be released in early 2011.

Kayani N, Cleveland MJ. 2011 Summer Research Fellowship Program. The use of an electronic medical record and other interactive strategies in Geriatric Medicine Rotations.

Allen, K., for his role in the video series: AEGIS Video & Film Production Awards 2010 Winner. AHRQ Health Care Quality: Frontline Innovators on Changing Care, Improving Health. Post-discharge Care Management Integrates Medical and Psychosocial Care of Low-Income Elderly Patients http://www.innovations.ahrq.gov/videos.aspx.

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Allen K, Radwany S, Holder C, Lipson D, Libersky J. AHRQ PCMH Project: Summa Health System’s experience in serving adults with complex care needs. Mathematica Policy Research, Inc., Washington, DC, May 5, 2011. Via conference call to speak about the many programs that Summa Health System has developed to serve the most complex patients.

Allen K, Holder C, Ruby J. Affordable Care Act Webinar. Care Transitions in Action: From Hospital to Home in Two Communities. Sponsored by the U.S. Department of Health & Human Services, Administration on Aging, Washington, D.C., March 30, 2011.

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Garner M, Fosnight S, Letting-Mangira D, Baum E, Wilford R, Allen K, Hazelett S, Benedict L, Hewit M. The Effect of Haloperidol Loading Dose on the Duration of Delirium. 2011 ACCP Annual Meeting, Pittsburgh, PA, October 16-19, 2011.

Benedict L. Outcomes of an Acute Delirium Detection, Prevention and Treatment Intervention Program. Summa Affiliate Robinson Memorial Hospital Nursing Research Day, Ravenna, OH, April 29, 2011.

Deen, M. The Effect of Haloperidol Loading Dose on the Duration of Delirium. Great Lakes Residency Conference, Purdue University, West Lafayette, IN, April 28, 2011.

Allen K. Best Practices Featuring Active Community-based Programs Delivering Medical and Social Services presented during the Linking the Social and Medical Models through Care Coordination in the Aging Network session. ASA AGING IN AMERICA: N3C NYAM Day-long Session, San Francisco, CA, April 27, 2011.

Allen K, Gong J, Gorwin J. Strategic Options for Hospice and Palliative Care in the Era of Accountable Care Organizations. NHPCO 26th Management & Leadership Conference, Baltimore, MD, April 7, 2011.

Radwany S, Allen K, Holder C, Kousaie K. Palliative Care, Geriatric Medicine and Community Collaboration Across the Continuum, San Diego Hospice, San Diego, CA, April 7, 2011.

Ludwick R, Baughman K, Merolla D, Hazelett S, Palmisano B, Winchell J, Hewit M. Predictive Factors for the Initiation of Advance Care Planning by R.N.s and Social Workers. 2011 Midwest Nursing Research Society Annual Conference Program, Columbus, OH, March 26, 2011.

Radwany S, Allen K, Holder C, Kousaie K. Palliative Care, Geriatric Medicine and Community Collaboration Across the Continuum. Capital Hospice, Arlington, VA, March 25, 2011.

Allen K. Caring for Patients with Advanced and Serious Illnesses: Changing Medical Practice and Patient Expectations. National Health Policy Forum, Washington, DC, March 18, 2011.

Benedict L, Fosnight S. Components of the Delirium Initiative. Crystal Clinic Orthopedic Center: Nurse Champions, Akron, OH, March 17, 2011.

Benedict L, Sabo A, Holder C. Delirium Panel Discussion. Advanced Medical Surgical Workshop, Summa Health System, Akron, OH, March 3, 2011.

Radwany S, Allen K, Holder C, Kousaie K. Palliative Care, Geriatric Medicine and Community Collaboration Across the Continuum. AAHPM annual meeting, Vancouver, Canada, Feb. 16-19, 2011.

Radwany S. Palliative Care, Geriatric Medicine and Community Collaboration across the Continuum. San Diego Hospice, San Diego, CA, April 7, 2011.

Radwany S. Palliative Care, Geriatric Medicine and Community Collaboration across the Continuum. Capital Hospice, Arlington, VA, March 25, 2011.

Radwany S, Hudak C, Allen K, Holder C. Palliative Care, Geriatric Medicine and Community Collaboration across the Continuum. AAHPM Annual Meeting, Vancouver, BC, February, 2011.

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2 0 1 1 A c c o m P l i S H m e n t S32

medicAl StAff for tHe inStitute for Senior And PoSt Acute cAre

mAryjo l. clevelAnd, m.d.Interim, Chief, Division of GeriatricsInterim, Co-Medical Director, Institute for Senior and Post Acute CareMedical Director, Center for Senior HealthBoard certified in geriatrics medicine

tHomAS breen, m.d., PH.d.Medical Director New Horizons Adult Day ServicesSummaCare Physician House Calls Board certified in geriatrics and internal medicine

r. dAniel cevASco, jr., m.d.Associate Medical Director Summa’s Palliative Care and Hospice Services Board certified in family medicine and holds Certificate of added qualifications in palliative medicine

Steven rAdwAny, m.d., fAcP, fAAHPmInterim, Co-Medical Director, Institute for Senior and Post Acute CareMedical Director, Summa’s Palliative Care and Hospice ServicesProgram Director, Palliative Medicine and Hospice FellowshipChair, Ethics CommitteeBoard certified in geriatrics, hospice and palliative medicine and internal medicine

kevin f. dieter, m.d., fAAHPmAssociate Medical Director Summa’s Palliative Care and Hospice ServicesBoard certified in family medicine and holds Certificate of added qualifications in palliative medicine

nAncy A. iSteneS, d.o., cmdMedical Director, Long-term and Transitional Care Services, Summa’s HomeCare and Geriatric Rehabilitation UnitsBoard certified in geriatrics and internal medicine

timotHy lewiS, m.d.Board certified in geriatrics and internal medicine

Preeti betkerur, m.d.Board certified in geriatrics and internal medicine

PHySiciAnS

cHArinA GAyomAli, m.d. Medical Director, Palliative Care Clinic Board certified in internal medicine, nephrology and hospice and palliative medicine

joHn A. kASPer, m.d.Board certified in general psychiatry, forensic psychiatry and geriatric psychiatry

cAtHerine S. mAxwell, m.d., fAcPMedical Director Geriatric Inpatient Consult ServiceBoard certified in geriatrics and internal medicine

cHriStine d. HudAk, m.d., fAAfPAssociate Medical Director Summa’s Palliative Care and Hospice ServicesBoard certified in family medicine and holds Certificate of added qualifications in palliative medicine

nAtAlie A. kAyAni, m.d.Medical Director Geriatric Medical EducationBoard certified in geriatrics and internal medicine

SHorin nemetH, d.o.Medical Director Palliative Care Summa Western Reserve HospitalBoard certified in internal medicine


kAtHleen SenGer, m.d.Associate Medical Director Summa’s Palliative Care and Hospice ServicesBoard certified in hospice and palliative medicine and internal medicine

SArA Snyder, d.o.Board certified in family medicine

lAurie brown-croytS, mSn, cnPAANP certified adult nurse practitioner

micHAel klein, mSn, crnPAANP certified adult nurse practitioner

PAtriciA GoSSett, mSn, cnPANCC board certified acute care nurse practitioner

StAcie ScHreiner, mSn, cnPAANP certified adult nurse practitioner

meliSSA SoltiS, m.d.Associate Medical Director Summa’s Palliative Care and Hospice ServicesBoard certified in hospice and palliative medicine and internal medicine

betH A. ezzie, mSn, cnPANCC board certified geriatric nurse practitioner

HAllie mASon, mSn, crnPANCC board certified in family practiceNBCHPN board certified advanced practice palliative care management

AmAndA HArvAn, mS, cnPANCC board certified adult nurse practitioner

SAndy SHAw, mSn, crnPAANP certified adult nurse practitioner

SArAH Gedeon, mSn, cnPANCC board certified geriatric nurse practitioner

kelly mcGrAnAHAn, mSn, crnPAANP certified adult nurse practitioner

ericA lynn HoileS, mSn, crnPAANP certified adult nurse practitioner

Scott SPillAn, mSn, cnPAANP certified adult nurse practitioner

m e d i c A l S t A f f f o r t H e i n S t i t u t e f o r S e n i o r A n d P o S t A c u t e c A r e

nurSe PrActitionerS

SimonA SucHAn, m.d.Board certified in general psychiatry and geriatric psychiatry

34

reGionAl GeriAtric And PAlliAtive medicine PHySiciAnS

toSAddAQ AHmed, m.d.Board certified in geriatricsSumma Akron City and St. Thomas Hospitals

irene m. cHenowitH, m.d.Board certified in internal medicine and geriatrics Summa Akron City and St. Thomas Hospitals

Steven l. cocHrAn, m.d.Board certified in family medicine and holds a Certificate of added qualifications in geriatric medicineSumma Akron City and St. Thomas Hospitals

mAttHew P. finnerAn, m.d.Board certified in geriatricsSumma Wadsworth-Rittman Hospital

jAmeS f. Grow, m.d.Board certified in family medicine and holds a Certificate of added qualifications in geriatric medicineSumma Akron City and St. Thomas Hospitals

jyotHi d. GudlA, m.d.Board certified in internal medicine and geriatrics Summa Akron City and St. Thomas Hospitals

rodney iSon, m.d.Board certified in family medicine and holds a Certificate of added qualifications in geriatric medicineSumma Barberton Hospital

jeffrey A. kASe, m.d.Board certified in family medicine and holds a Certificate of added qualifications in geriatric medicineSumma Physicians Inc.

bonG S. kAuH, m.d.Board certified in internal medicine and geriatrics Summa Akron City and St. Thomas Hospitals

dAvid r. lAnce, d.o.Board certified in geriatrics, hospice and palliative medicineSumma Wadsworth-Rittman Hospital

brAdley r. mArtin, m.d.Board certified in internal medicine, critical care and geriatrics Summa Akron City and St. Thomas Hospitals Summa Barberton Hospital

kenelm f. mccormick, m.d.Board certified in family medicine and holds a Certificate of added qualifications in hospice and palliative medicineSumma Wadsworth-Rittman Hospital

dAniel l. Steidl, m.d.Board certified in internal medicine and geriatrics Summa Akron City and St. Thomas Hospitals

j. dAvid StokeS, m.d.Board certified in family medicine and holds a Certificate of added qualifications in geriatric medicineSumma Barberton Hospital


SEN-11-13815/CPS/EH/11-11/11,304

Summa Health System serves more than one million patients each year in

comprehensive emergency, acute, critical outpatient and long-term

home-care settings and represents more than 2,000 licensed, inpatient beds

on the campuses of Summa Akron City Hospital, Summa Barberton Hospital,

Summa St. Thomas Hospital, Summa Wadsworth-Rittman Hospital,

Summa Western Reserve Hospital, Robinson Memorial Hospital, an affiliate

of Summa Health System, and Crystal Clinic Orthopaedic Center, a joint

partnership with Summa Health System. In addition, outpatient care is extended

throughout a five county region in more than 20 community health centers.

For more information, visit our website: summahealth.org

summa geriatrics/media/files/pdfs/pressroom/... · 2012. 9. 21. · a su m m a he a l t h sy s t e...

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