University of Wisconsin Active Aging Research Center

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Slide 1

University of Wisconsin Active Aging Research Center

National Advisory Committee (NAC) Report and Update
Dave Gustafson, Principal Investigator (PI)
July 25 2012

Slide 2

Thank You!

Slide 3

Over 600,000 will enter nursing homes (NHs) in 2012.

Average NH stay 893 days; $161,500/admission.

Total cost exceeds: $10,000,000,000.

Many people do not enter poor, but they leave poor.

Slide 4

Does it have to be that way?

Image: A bar graph compares annual per capita healthcare costs by age for the United States with the U.K., Germany, Sweden, and Spain. From age 67 up, U.S. per capita healthcare costs are significantly higher than the other countries.

Slide 5

Active Aging Research Center

Images: The logo of the University of Wisconsin is shown. Photographs of a city by a river, a small town main street, and a farm in the countryside are captioned "Milwaukee County," "Waukesha County," and "Richland County" respectively.

Slide 6

What will ECHESS be?

Image: A child's drawing shows houses and a square building labeled "Community Center" on the rim of a globe.

Slide 7

Elevator Speech

• There are many good technologies, products, and online resources to help the elderly remain independent.  Few are used. 
• Why? 
  • Disparate stand-alone products and services.
  • Not proven to work.
  • Not sanctioned by trusted organizations.
  • Environment is not prepared to adopt, sustain and spread. 
• ECHESS will:
  • Integrate key technologies.
  • Test them to find which parts work, with who, and how.
  • Work with communities, payers, elders, families and clinicians, to ensure that ECHESS honors the strengths and limitations of everyone. 
  • Make independence-empowering technology accessible to all.
  • Do it within a walled garden.
  • Improve outcomes including costs.
  • Reduce re-admissions to hospitals and emergency departments.

Slide 8

National Advisory Committee (PoA)

• Sandra J. Ball-Rokeach: Professor, Communications, USC.
• Paul Batalden: Professor, Dartmouth Health Policy and Clinical Practice.
• Noshir Contractor: Northwestern Science of Networks Research.
• Brian Joiner: Founder Joiner Associates Inc. Quality Improvement.
• Peter Kissinger: President AAA Foundation for Traffic Safety.
• Adrian K. Lund: President, Insurance Institute for Highway Safety.
• Jeffrey Michael: Assoc Administrator, National Highway Traffic Safety Admin.
• Brian McLaughlin: Assoc Administrator, National Highway Traffic Safety Admin.
• Wendy J. Nilsen: Administrator, NIH Behavioral & Social Science Research.
• Kevin Patrick: Professor, Preventive Medicine, UCSD.
• Susan C. Reinhard: Senior Vice President for Public Policy at AARP.
• David Rose: Innovator, Vitality LLC.
• Vinod K. Sahney, PhD: Senior Fellow, Institute for HealthCare Improvement.
• Andrew H. Van de Ven: Professor, Organizational Innovation, Minnesota.
• Nancy A. Whitelaw: President, Gerontological Society of America.
• Clive Hohberger: President (Ret) Zebra Tech; Automatic identification technology.

Slide 9

Goals:

Use sensors, information & communication technology
To help elders & family improve:

• Service dependability.
• Loss of driving privileges.
• Quality of life.
• Medication management.
• Falls.
• Readmissions.

Sustain and spread to 20 other Wisconsin counties.

Slide 10

Focus:

Older adult (>70; Hospital discharge in 180 days) and Family caregiver (Distant; Nearby; Live-in)

Measures

• Primary:
  • Readmissions to hospital.
  • Health care costs.
  • % now living in ALF or NH.
  • Quality of life.
• Asset Based Community Development:
  • # uses of community resources.
  • Type of resources used.
  • Have organizations to take on ECHESS.
• Isolation:
  • Number of contacts per day.
  • Minutes of contacts per day.
• Driving:
  • Attend appointments.
  • Accidents per driver.
  • Number still driving.
  • Number rapid stops & starts.
• Service Dependability:
  • Service timeliness.
  • Anxiety of family caregiver.
  • Satisfaction w service quality.
• Medication:
  • Number of adverse events.
  • Missed medications rates.

Slide 11

Premise: Technology Can Help

Images: Photographs of a handheld PDA, a Kindle, a laptop computer, and a collection of electronic components are shown.

Slide 12

Two interlocking systems

Images: Two screenshots from a handheld device tool are shown. The first is captioned "Older adult" and shows the date, weather, a menu that includes "Connect with others," "Manage my health," and "Update my status," as well as a reply to a message, "Looking forward to it!" with a note to "See & update my schedule." The second screenshot is captioned "Family" and shows a photograph of an elderly man above a menu that includes "Check in with Dad," "Connect with others," and "Report how Dad's been doing." The text "Very Preliminary" is superimposed over both screenshots.

Slide 13

Our challenge: Making a complex system simple.

Image: A complex system is shown.

Slide 14

NAC suggested Next Steps

• Stories from each group [Image: check mark].
• Decide on measures [Image: check mark].
• Elevator speech [Image: check mark].
• Baseline data: Starting.
• Target population defined [Image: check mark].
• Simplify.
• Increase size of RCT: Exploring.
• Interview OAs forced to go to NH or ALF: Starting.
• Doing too much.

Slide 15

Activity

• Needs & Assets:
  • Over 200 elders interviewed.
  • Information classified.
  • Loneliness, Transport & Community events.
• Developed:
  • Stories.
  • Vision.
  • Elder Tree.
• Being Developed:
  • Loneliness:
    • Community Calendar & matching.
  • Medication:
    • Side effects predictor.
    • Glow-Caps.
  • Falls:
    • Booster.
    • Gait.
  • Driving:
    • Sensors measuring drives.
  • Service Dependability:
    • Pilot testing in rural area.

Slide 16

Next Steps

• Waukesha County:
  • New Berlin.
  • Implement Elder Tree in 1000 households.
    • Getting Community Buy-in.
    • Seeking resources.
• Milwaukee County (urban):
  • Northwest area.
  • Building political base.
  • Completing asset assessment.
• Richland County (rural):
  • Community bought in.
  • Asset assessment done.
  • Community calendar.
• Systems development:
  • Programming.
  • Data collection.
  • Pilot tests.
  • Integration.
• Prepare randomized trial:
  • Final outcomes & measures.
  • ADRCs prepare to recruit.

Slide 17

To sustain, technology needs support systems

• Financing.
• Incentives.
• Processes.
• Regulations.
• Interagency agreements.
• Welcoming environment.
• Community development.

Working on this now.

Slide 18

NAC Caution

We are trying to do too much!

Maybe. We'll see.

Slide 19

Thank you again