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Acute Care for Elders (ACE) Tracker and e-Geriatrician: Methods to Disseminate ACE Concepts to Hospitals with No Geriatricians on Staff

Authors

  • Michael L. Malone MD,

    1. From the *Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Milwaukee, Wisconsin; Senior Services Program, Aurora Health Care, Milwaukee, Wisconsin; Aurora Health Care, Milwaukee, Wisconsin; and §Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas.
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  • Marsha Vollbrecht MS,

    1. From the *Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Milwaukee, Wisconsin; Senior Services Program, Aurora Health Care, Milwaukee, Wisconsin; Aurora Health Care, Milwaukee, Wisconsin; and §Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas.
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  • Jeff Stephenson MS,

    1. From the *Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Milwaukee, Wisconsin; Senior Services Program, Aurora Health Care, Milwaukee, Wisconsin; Aurora Health Care, Milwaukee, Wisconsin; and §Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas.
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  • Laura Burke RN, PhD,

    1. From the *Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Milwaukee, Wisconsin; Senior Services Program, Aurora Health Care, Milwaukee, Wisconsin; Aurora Health Care, Milwaukee, Wisconsin; and §Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas.
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  • Patti Pagel RN,

    1. From the *Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Milwaukee, Wisconsin; Senior Services Program, Aurora Health Care, Milwaukee, Wisconsin; Aurora Health Care, Milwaukee, Wisconsin; and §Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas.
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  • James S. Goodwin MD

    1. From the *Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Milwaukee, Wisconsin; Senior Services Program, Aurora Health Care, Milwaukee, Wisconsin; Aurora Health Care, Milwaukee, Wisconsin; and §Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas.
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Address correspondence to Michael Malone, 1020 N. 12th Street, Milwaukee, WI 53233. E-mail: michael.malone.md@aurora.org

Abstract

This article describes an innovative method to disseminate the Acute Care for Elders (ACE) model of care for hospitalized older patients implemented at 11 community hospitals in Wisconsin. The ACE Tracker is a computer-generated checklist of all older patients in a facility that takes information from multiple areas of the electronic medical record to identify the older patients' risk factors for functional decline and poor outcomes. The ACE Tracker report was validated against in-person observation of the older patients and found to be accurate. Interdisciplinary teams on medical–surgical units use this summary report to review each patient's plan of care and to efficiently assess the patients who are vulnerable to poor hospital outcomes. The ACE Tracker is also used during regular consultation provided through teleconferencing between an off-site geriatrician (e-Geriatrician) and the local ACE team. The effect of the ACE Tracker and e-Geriatrician models was assessed by measuring use of urinary catheters, physical restraints, high-risk medications, and social service evaluation at a single hospital for the 6 months before and after implementation of the models. There were significant improvements in urinary catheter and physical therapy referrals but no significant changes in the other outcomes. There was no change in the length of stay or in the rate of hospital readmission within 30 days.

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