GARY AND MARY WEST HEALTH INSTITUTE

OVER THE COURSE OF 2023, THE GARY AND MARY WEST INSTITUTE (REFERRED TO BELOW VARIOUSLY AS WHI, WEST HEALTH INSTITUTE, OR INSTITUTE) CONTINUED TO ACTIVELY CONDUCT APPLIED MEDICAL RESEARCH, IN CONJUNCTION WITH THE HOSPITALS LISTED ON SCHEDULE A, WITH THE OBJECTIVE OF CONTRIBUTING TO THE BODY OF CLINICAL, SCIENTIFIC, AND HEALTH KNOWLEDGE THAT CAN ULTIMATELY BENEFIT OLDER ADULTS IN AMERICA. OUR RESEARCH METHODOLOGIES ENCOMPASS A VARIETY OF REAL-WORLD DATA COLLECTION AND ANALYSIS TECHNIQUES, AND IN MANY CASES, WE IMPLEMENT PROGRAMS AND STRUCTURES (E.G., STANDARDIZED CARE MODELS, DATA DASHBOARDS, ETC.) THAT ALLOW US TO COLLECT SYSTEMATIZED RESEARCH INFORMATION WHERE LITTLE PREVIOUSLY EXISTED. THESE MEDICAL RESEARCH EFFORTS DIRECTLY SUPPORTED WHI'S MISSION OF LOWERING THE COST OF HEALTHCARE AND ENABLING SENIORS TO SUCCESSFULLY AGE IN PLACE WITH ACCESS TO HIGH-QUALITY, AFFORDABLE HEALTH AND SUPPORT SERVICES THAT PRESERVE AND PROTECT THEIR DIGNITY, QUALITY OF LIFE AND INDEPENDENCE. OUR MAJOR WORKSTREAMS FOR 2023 BROADLY FIT INTO THE AREAS OF (SENIOR APPROPRIATE) ACUTE CARE RESEARCH, CHRONIC CARE RESEARCH, AND TELEHEALTH RESEARCH AND ARE DESCRIBED BELOW. SENIOR-APPROPRIATE ACUTE CARE RESEARCH IN 2023, THE INSTITUTE CONTINUED TO EXPAND ITS RESEARCH PORTFOLIO AND GROW THE BODY OF EVIDENCE FOR NEW STRATEGIES IN ACUTE CARE. UNPLANNED (ACUTE) NEEDS REMAIN THE PRIMARY DRIVER OF COSTS FOR THE NATION'S VULNERABLE OLDER ADULTS, AS WELL AS LEADING TO LASTING DETRIMENTAL EFFECTS (E.G., POST-VISIT DEBILITATION AND FUNCTIONAL DECLINE). SUCCESS IN THIS AREA IS ESSENTIAL TO ACHIEVING BETTER, MORE AFFORDABLE OUTCOMES FOR OLDER ADULTS. ACUTE CARE RESEARCH AREA: GERIATRIC EMERGENCY DEPARTMENTS (GEDS) MEET THE DEMANDS OF A GROWING GED MOVEMENT, EVALUATE THE CLINICAL IMPACT, AND DEVELOP A SUSTAINABILITY PLAN TO ENSURE LONG TERM SUCCESS OF THE GEDA PROGRAM. OUR PARTNERSHIP WITH THE AMERICAN ACADEMY OF EMERGENCY PHYSICIANS (ACEP) WAS FOCUSED IN 2023 ON IMPROVING THEIR APPLICATION PROCESS BY ENABLING TECHNOLOGY IMPROVEMENTS AND CREATING APPLICATION THROUGHPUT EFFICIENCY. A NEW TECHNOLOGY PLATFORM WAS INITIATED TO PROCESS THE INCREASING APPLICATION DEMANDS, AND STAFF WERE BROUGHT ON TO MEET THE NEEDS OF IMPROVING APPLICATION THROUGHPUT. AS A RESULT, APPLICATION THROUGHPUT TIME IMPROVED, ALLOWING MORE 65+ PATIENTS TO HAVE ACCESS TO A GED AT A LOCAL HOSPITAL NEAR THEM THIS YEAR. (AT THE CLOSE OF 2023, GEDS COULD BE FOUND IN WELL OVER 400 HOSPITALS ACROSS THE US.) THIS YEAR WHI ALSO FOCUSED ON DEMONSTRATING CLINICAL IMPACT, FINANCIAL ROI, AND DRIVE QUALITY IMPROVEMENT. ONE WAY THAT WEST HEALTH AND ACEP HAVE PARTNERED TO ACHIEVE THIS IS THROUGH THE GED DASHBOARD, A MECHANISM MADE DIRECTLY AVAILABLE TO HOSPITALS AND HEALTH SYSTEMS FOR INDIVIDUAL ED SITES TO TRACK QUALITY IMPROVEMENT THROUGH AGGREGATE LEVEL DATA. BUILDING CASE FOR SUSTAINABILITY GERIATRIC EMERGENCY CARE IN PARTNERSHIP WITH CLEVELAND CLINIC: IN 2023, WEST HEALTH PARTNERED WITH CLEVELAND CLINIC (CC) TO STUDY THE PROCESS AND PROTOCOLS OF THE VARIOUS CLEVELAND CLINIC GED SITES TO BETTER UNDERSTAND HIGH-RISK GERIATRIC PATIENT OUTCOMES AND UNDERSTAND THE RETURN ON INVESTMENT. THIS CASE STUDY, SHARED VIA WEBINAR, FOUND A REDUCTION IN MEDICALLY UNNECESSARY ADMISSIONS WHICH FREED UP HIGH DEMAND IN-PATIENT BEDS AND RESULTED IN COST SAVINGS FOR THE (CC) HOSPITAL SYSTEM. WEST HEALTH AND CLEVELAND CLINIC JOINTLY CREATED A 2-PAGE SUSTAINABILITY CASE STUDY PROVIDING AN IMPORTANT PERSPECTIVE INTO THE BENEFITS BOTH CLINICALLY AND AS A RETURN ON INVESTMENT INTO THE VALUE OF PURSUING GED ACCREDITATION. IN ADDITION TO THE ABOVE, WEST HEALTH AND CLEVELAND CLINIC RESEARCH TEAMS FURTHER COLLABORATED IN DESIGNING A POST-IMPLEMENTATION EVALUATION OF CLEVELAND CLINIC'S NEW ELECTRONIC HEALTH RECORD-SUPPORTED DELIRIUM SCREENING PROCESS. IN PARTNERSHIP WITH THE STATEWIDE UC HEALTH SYSTEM: THE UNIVERSITY OF CALIFORNIA SAN DIEGO (UCSD) HOSPITAL HEALTH COLLABORATION SUCCESSFULLY PAVED THE WAY FOR ALL UC HEALTH SYSTEMS IN CALIFORNIA TO ACHIEVE LEVEL 1 GED ACCREDITATION WITH WHI SUPPORT. THIS YEAR, THE INSTITUTE COLLABORATED WITH UCSD TO CONDUCT AN OPERATIONAL STUDY TO DESCRIBE GED IMPLEMENTATION ACROSS THE 5 UC HEALTH GEDS, PROVIDING SUPPORT FOR DATA COLLECTION, ANALYSIS, INTERPRETATION OF RESULTS, AND DISSEMINATION. THE STUDY ASSESSED DRIVERS OF VARIATION, LESSONS LEARNED, AND IMPLEMENTATION FACILITATORS AND BARRIERS. A WORKSHOP WAS HELD WITH ALL UC SITES TO REVIEW, SYNTHESIZE, AND PLAN FOR DISSEMINATION OF THE STUDY'S RESULTS TO A VARIETY OF STAKEHOLDERS, INCLUDING PHYSICIANS, NURSES, AND RESEARCHERS. GERIATRIC EMERGENCY DEPARTMENT ACCREDITATION ENGAGEMENT WITH COMMUNITY HOSPITALS THROUGHOUT CALIFORNIA UC SAN DIEGO HEALTH PARTNERSHIP: THE GARY AND MARY WEST SENIOR CARE NETWORK (SECN) IS A STATEWIDE EFFORT TO ENSURE THAT CALIFORNIA BECOMES A LEADER IN EMERGENCY CARE FOR OLDER ADULTS. IN A CONCERTED EFFORT TO GROW THE SECN IN 2023, THE WEST HEALTH INSTITUTE AND UC SAN DIEGO HEALTH DEVELOPED A TRAINING PROGRAM TO TEACH AND ENCOURAGE ADOPTION OF THE GED MODEL ACROSS CALIFORNIA. THIS COLLABORATION STREAMLINED ENGAGEMENT, EDUCATION, AND SUPPORT FOR HOSPITALS AS THEY IMPLEMENTED THE GED MODEL. OUTREACH WAS CONDUCTED WITH OVER 600 INDIVIDUALS THROUGHOUT THE STATE, WITH 130+ INDIVIDUALS ATTENDING TRAININGS, REPRESENTING 52 HOSPITALS ACROSS THE STATE. IN ADDITION, WHI AND THE TEAM AT UC SAN DIEGO HEALTH PROVIDED INDIVIDUALIZED SUPPORT TO HOSPITALS PURSUING GED ACCREDITATION. AS A DIRECT RESULT OF THESE EFFORTS AND MORE, NUMBER OF ACCREDITED GEDS IN CALIFORNIA INCREASED FROM 57 AT THE BEGINNING OF 2023 TO 82 ACCREDITED GEDS AS OF NOVEMBER 2023, IMPROVING PATIENT ACCESS TO OLDER ADULT APPROPRIATE EMERGENCY CARE THROUGHOUT THE STATE. HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA PARTNERSHIP: IN ADDITION TO THE PARTNERSHIP WITH UC SAN DIEGO HEALTH (ABOVE), WHI ALSO PARTNERED WITH THE HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA (HASC) TO DRIVE SPREAD AND ADOPTION OF THE GED MODEL. THROUGHOUT 2023, OVER 460 INDIVIDUALS AFFILIATED WITH HASC MEMBER HOSPITALS WERE INTRODUCED TO THE GED MODEL THROUGH THIS COLLABORATION. WHI PARTNERED WITH HASC TO PRESENT THE SECN INITIATIVE AT THE HASC ANNUAL MEETING EXECUTIVE FORUM IN MAY 2023, EMPHASIZING THE CASE FOR IMPROVING GERIATRIC EMERGENCY CARE. 75 INDIVIDUALS ATTENDED VIRTUAL "ADVANCING GERIATRIC EMERGENCY CARE: BEST PRACTICES AND ACCREDITATION STRATEGIES" TRAINING CO-HOSTED BY WHI AND UC SAN DIEGO HEALTH, REPRESENTING 38 HOSPITALS ACROSS SOUTHERN CALIFORNIA. PRIOR TO THIS INITIATIVE, 27 HASC MEMBER HOSPITALS HAD ACHIEVED GED ACCREDITATION. AS A RESULT OF THIS COLLABORATION EIGHT (8) MORE HASC MEMBER HOSPITALS HAVE APPLIED FOR OR ACHIEVED GED ACCREDITATION IN 2023, WITH ADDITIONAL HOSPITALS CONTINUING TO PURSUE GED ACCREDITATION INTO 2024. KAISER PERMANENTE SOUTHERN CALIFORNIA PARTNERSHIP: SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP (SCPMG) IS A LEADING DRIVER IN CLINICAL CARE FOR OVER 4 MILLION MEMBERS, AND WITH AN AGING POPULATION SCPMG RECOGNIZED THE NEED TO PROVIDE GERIATRIC SPECIFIC EMERGENCY CARE TO ITS REGIONAL MEMBERS. IN PARTNERSHIP WITH AND SUPPORTED BY WEST HEALTH, 60+ INDIVIDUALS AFFILIATED WITH 17 SCPMG MEMBER HOSPITALS WERE EDUCATED ABOUT THE GED MODEL. WHI PARTNERED WITH SCPMG TO PRESENT THE GED ACCREDITATION INITIATIVE TO HEALTH SYSTEM ASSISTANT MEDICAL GROUP ADMINISTRATORS AND ASSISTANT AREA MEDICAL DIRECTORS IN OCTOBER 2023. THIRTY-NINE (39) INDIVIDUALS ATTENDED VIRTUAL "ADVANCING GERIATRIC EMERGENCY CARE: BEST PRACTICES AND ACCREDITATION STRATEGIES" TRAININGS CO-HOSTED BY WHI AND UCSD, REPRESENTING 15 HOSPITALS ACROSS SOUTHERN CALIFORNIA. PRIOR TO THIS INITIATIVE, FOUR (4) SCPMG HOSPITALS HAD ACHIEVED GED ACCREDITATION. AS A RESULT OF THIS COLLABORATION FOUR (4) MORE SCPMG HOSPITALS APPLIED FOR GED ACCREDITATION IN 2023, WITH AN ADDITIONAL NINE (9) HOSPITALS CONTINUING TO PURSUE GED ACCREDITATION INTO 2024. EXTENDING GEDS IN RURAL CRITICAL ACCESS HOSPITALS IN 2023, THE INSTITUTE CONCLUDED ITS MULTI-YEAR COLLABORATION WITH DARTMOUTH HITCHCOCK MEDICAL CENTER WHICH INCLUDED SUPPORTING TWO RURAL CRITICAL ACCESS HOSPITALS IN NEW ENGLAND TO ACHIEVE LEVEL 2 GED ACCREDITATION USING RESEARCH AND LEARNINGS FROM WORK WITH DARTMOUTH HITCHCOCK IN 2022 IN TO SUPPORT GEDS WITHIN THEIR SYSTEM. THE GERIATRIC EMERGENCY DEPARTMENT COLLABORATIVE (GEDC): BUILDING MEDICAL RESEARCH EXCELLENCE IN THE GED COMMUNITY IN PARTNERSHIP WITH YALE HEALTH: IN 2023, OUR WORK WITH THE GEDC AT YALE FOCUSED ON EXPLORING THE USE OF SECONDARY DATASETS TO EVALUATE GEDS AND RESULTED IN SEVERAL CONFERENCE PRESENTATIONS AND A MANUSCRIPT IN ANNALS OF EMERGENCY MEDICINE. WHI ADDITIONALLY SUPPORTED YALE IN ESTABLISHING A DATA PLATFORM AND LEVERAGING THIS TO PERFORM PILOT STUDIES THAT WERE JOINTLY FUNDED BY THE NATIONAL INSTITUTES OF HEALTH.