Gary And Mary West Health Institute

CONDUCTING MEDICAL RESEARCH WITH HOSPITALS TO REDUCE HEALTHCARE COSTS WITH A FOCUS ON SENIORS.

OVER THE COURSE OF 2021, 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 PUT IN PLACE 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 2021 BROADLY FIT INTO THE AREAS OF (SENIOR APPROPRIATE) ACUTE AND CHRONIC CARE RESEARCH AND ARE DESCRIBED BELOW.SENIOR-APPROPRIATE ACUTE CARE RESEARCH IN 2021, THE INSTITUTE CONTINUED TO EXPAND ITS RESEARCH PORTFOLIO AND GROW THE BODY OF EVIDENCE FOR NEW STRATEGIES IN ACUTE CARE. UNPLANNED (ACUTE) HEALTH NEEDS REMAIN THE PRIMARY DRIVER OF COST FOR THE NATION'S VULNERABLE OLDER ADULTS, AS WELL AS LEADING TO LASTING DETRIMENTAL EFFECTS (E.G., POST HOSPITAL DEBILITATION AND FUNCTIONAL DECLINE). SUCCESS IN THIS AREA IS ESSENTIAL TO ACHIEVING BETTER, MORE AFFORDABLE OUTCOMES FOR OLDER ADULTS. RESEARCH PROJECT: GERIATRIC EMERGENCY DEPARTMENTS (GEDS)SYSTEMATIZING DATA AND INTERVENTIONS (ACCREDITATION)WHEN OLDER ADULTS ENCOUNTER HEALTH AND/OR SOCIAL CHALLENGES, THE EMERGENCY DEPARTMENT AT A LOCAL HOSPITAL IS MOST OFTEN THE FIRST PLACE WHERE THEY PRESENT. AS SUCH CREATING A SYSTEM OF EMERGENCY DEPARTMENTS THAT ARE 1) EQUIPPED TO RECOGNIZE AND COLLECT INFORMATION ABOUT OLDER ADULTS' HEALTH STATUS AS WELL AS TO 2) DEPLOY A STANDARDIZED SET OF INTERVENTIONS AND GENERATE DATA ABOUT THE EFFECTIVENESS OF THESE INTERVENTIONS, IS AN IMPORTANT RESEARCH PLATFORM FOR IMPROVING OUTCOMES FOR SENIORS. WHI IS USING THE GERIATRIC EMERGENCY DEPARTMENT ACCREDITATION PROGRAM AS A VEHICLE TO ACHIEVE THESE RESEARCH AIMS. THE WHI-SUPPORTED GEDA PROGRAM AWARDED 100 SITE ACCREDITATIONS IN 2021. AS OF DECEMBER 2021, THE PROGRAM INCLUDED OVER 280 TOTAL HOSPITAL EMERGENCY DEPARTMENT (ED) SITES SPREAD ACROSS THE UNITED STATES REPRESENTING OVER 210 CITIES AND TOWNS ACROSS 41 STATES. COUNTRY-WIDE INTEREST IN THE GEDA PROGRAM HAS RESULTED IN A HIGH NUMBER OF APPLICATIONS WITH OVER 70 APPLICATIONS CURRENTLY IN THE PIPELINE AND INTEREST EXPRESSED BY AN ADDITIONAL 182 SITES, PRIORITIES FOR GEDA IN 2022 INCLUDE EXPANDING THE REVIEW BOARD AS WELL AS STREAMLINING THE APPLICATION PROCESS.CALIFORNIA HAS CREATED A STATE MASTER PLAN FOR AGING, AND IS ACTIVELY SEEKING DATA, INCLUDING AND ESPECIALLY FROM EMERGENCY DEPARTMENTS. IN ADDITION TO EFFORTS AT THE NATIONAL LEVEL, WHI HAS ADDITIONALLY PUSHED FORWARD THE CREATION OF A GED RESEARCH NETWORK IN CALIFORNIA LED BY THE STATE ACADEMIC HEALTH RESEARCH INSTITUTIONS, AND IS PURSUING A "HUB-AND-SPOKE" MODEL, WHICH INVOLVES ESTABLISHING A HUB SITE AT THE MAJOR MEDICAL RESEARCH CENTERS WITHIN EACH UC HEALTH SYSTEM ED AS A LEVEL 1 (TOP LEVEL) ACCREDITED GED. ALL FIVE UC FLAGSHIP HOSPITALS, UC SAN DIEGO, UC SAN FRANCISCO, UC DAVIS, UC LOS ANGELES, AND UC IRVINE ARE NOW LEVEL 1 ACCREDITED (OR HAVE APPLIED). STUDYING AND SHARING/PUBLISHING WHAT WORKS (THE GERIATRIC EMERGENCY DEPARTMENT COLLABORATIVE)AS PART OF OUR EFFORTS TO CONTINUE TO LEARN AND ASSESS WHAT CONSTITUTES BEST PRACTICES IN GERIATRIC EMERGENCY MEDICINE (I.E., WHICH INTERVENTIONS ARE EFFECTIVE), WHI HAS CO-CREATED AND SUPPORTS THE GERIATRIC EMERGENCY DEPARTMENT COLLABORATIVE (GEDC), WHICH IS COMPRISED OF A CORE GROUP OF GERIATRIC EMERGENCY MEDICINE KNOWLEDGE LEADERS AND RESEARCHERS AS WELL AS MEMBER HOSPITAL SITES THAT HAVE GEDS. BY CONVENING EXPERT GED CLINICIANS FROM MEMBER EDS/HEALTH SYSTEMS, AND WITH SUPPORT FROM THE INSTITUTE AND OTHER STAKEHOLDERS, GEDC MEMBERS' RESEARCH CONTINUED TO PROVIDE EVIDENCE THAT GED GUIDELINE-BASED CARE IMPROVES PATIENT OUTCOMES AND IS COST EFFECTIVE. RESEARCH CONDUCTED BY THE GEDC RANGES FROM CASE-STUDIES TO TRADITIONAL CONTROLLED TRIALS FOR PUBLICATION IN PEER-REVIEWED SCIENTIFIC JOURNALS. SEVERAL HIGH-PROFILE PUBLICATIONS BY GEDC FACULTY AND OTHER COLLABORATORS HAVE DEMONSTRATED THE VALUE OF GEDS TO PATIENTS, HOSPITALS, AND PAYORS. THE GEDC ALSO AIDS IN DISSEMINATION OF RESEARCH FINDINGS BEYOND A PUBLICATION MECHANISM. IN DIRECT RESPONSE TO THE GLOBAL PANDEMIC, IN 2021 THE GEDC CONTINUED TO RELEASE COVID-SPECIFIC EDUCATIONAL MATERIALS IN THE FORM OF WEBINARS, PODCASTS, AND BLOG POSTS. THE GEDC ALSO CONTINUED TAILORING THEIR EDUCATIONAL AND TRAINING OFFERINGS TO A WEB-BASED PLATFORM TO ACCOMMODATE VIRTUAL AUDIENCES; CONVENED SUBJECT MATTER EXPERTS FOR MONTHLY WEBINARS; PUBLISHED AND DISSEMINATED BEST PRACTICES (E.G., BLOGS, WHITEPAPERS, ARTICLES); DEVELOPED A COVID-19 TOOLKIT; AND ESTABLISHED AN ONLINE RESOURCE LIBRARY. THE GEDC AND WHI BUILT MOMENTUM TO LEVERAGE INSIGHTS FROM ACTIVE ACCREDITED HEALTH SYSTEMS THROUGH THE HEALTHCARE SYSTEMS ROUNDTABLE AS A VEHICLE FOR SHARING REAL-WORLD RESEARCH FINDINGS ON GERIATRIC EMERGENCY CARE METHODS AND DEPLOYMENTS (SHARING BOTH SUCCESSES AND LESS-THAN-SUCCESSFUL RESULTS). IN 2021, THE HEALTHCARE SYSTEMS ROUNDTABLE TOPICS INCLUDED DELIRIUM SCREENINGS AND COVID-19 CARE IN THE GED. GERIATRIC EMERGENCY MEDICINE RESEARCH AT LARGE SCALE (VETERANS HEALTH ADMINISTRATION (VHA) GERIATRIC EMERGENCY RESEARCH NETWORK)THE VETERANS HEALTH ADMINISTRATION HOSPITAL SYSTEM REPRESENTS PERHAPS THE SINGLE GREATEST HOSPITAL/MEDICAL RESEARCH VENUE IN THE NATION. WITH A SYSTEM OF OVER 170 MEDICAL CENTERS ALL SHARING THE SAME ELECTRONIC HEALTH RECORD SYSTEM AND LARGELY SERVING AN OLDER POPULATION, THE VA IS AN IDEAL SYSTEM IN WHICH TO ADVANCE RESEARCH ON GERIATRIC EMERGENCY DEPARTMENTS, INCLUDING BOTH PROCESS AND OUTCOME MEASURES. TO THIS END, IN 2021, THE INSTITUTE PARTNERED WITH THE VHA AND OTHERS INCLUDING THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS, THE GERIATRIC EMERGENCY DEPARTMENT COLLABORATIVE AND THE JOHN A. HARTFORD FOUNDATION TO IMPLEMENT AND SCALE GEDS THROUGHOUT THE ENTIRE VHA SYSTEM, ACHIEVING 100% ENGAGEMENT OF VETERANS INTEGRATED SERVICE NETWORK (VISN) REGIONS. AS OF DECEMBER 2021, OVER 50 VHA EDS ARE ENGAGED IN GED PROGRAMMING WITH 16 OF 110 VHA EDS HAVING RECEIVED ACCREDITATION (14.6%) AND AN ADDITIONAL 24 APPLICATIONS IN THE ACCREDITATION WORKFLOW. SYSTEMATIC EVALUATION AND RESEARCH GERIATRIC EMERGENCY MEDICINE HAS BEEN ENABLED THROUGH THE CREATION AND ROLLOUT OF A NOVEL NATIONAL GERIATRIC ED DASHBOARD, A STANDARDIZED DATA COLLECTION MECHANISM AT ALL GED SITES. RESEARCHING NEW STANDARDIZED INTERVENTIONS FOR GEDS: (DELIRIUM RESOURCES FOR THE EMERGENCY DEPARTMENT)FAILURE TO RECOGNIZE AND APPROPRIATELY MANAGE PATIENTS TYPICALLY OLDER ADULTS WITH DELIRIUM IS ASSOCIATED WITH A 3-FOLD INCREASED RISK OF DEATH COMPARED TO THOSE WITHOUT DELIRIUM. THUS, THE ABILITY TO IDENTIFY AND TREAT DELIRIUM IN THE ED IS OF CRITICAL IMPORTANCE AS IT IS OFTEN MISSED IN THE EMERGENCY SETTING. TO SUPPORT EDS, AND GEDS IN PARTICULAR, IN ADDRESSING DELIRIUM, WHI COLLABORATED WITH THE MARCUS INSTITUTE FOR AGING RESEARCH TO SUPPORT RESEARCH DESIGNED TO HELP DEVELOP A CHANGE PACKAGE AND TOOLKIT SPECIFICALLY FOR THE ED- THE END PRODUCT OF WHICH WAS FINALIZED IN APRIL 2021. THE TOOLKIT CONTAINS A VARIETY OF CHANGE MANAGEMENT TOOLS, EDUCATIONAL RESOURCES, AND TEMPLATES TO ASSIST EDS WITH LAUNCHING DELIRIUM INITIATIVES. AS A FOLLOW-ON TO THIS WORK, THE INSTITUTE DEVELOPED A MANUSCRIPT BASED ON A FEASIBILITY PILOT WITH THREE EDS THAT IMPLEMENTED A DELIRIUM PROGRAM USING THE CHANGE PACKAGE AND TOOLKIT ST. MARY MERCY (LIVONIA, MICHIGAN), MAINE MEDICAL CENTER, AND UNIVERSITY OF NORTH CAROLINA HILLSBOROUGH (COMMUNITY HOSPITAL UNDER THE UNC HEALTH CARE SYSTEM). RESEARCH PROJECT: VALUE-BASED CARE HOME-BASED ACUTE CARE LEARNING AND ACTION NETWORK (VBC HOMELAN) IN ADDITION TO RESEARCHING NEEDS AND INTERVENTIONS IN THE EMERGENCY SETTING, AN IMPORTANT AREA OF INVESTIGATION IS UNDERSTANDING OPPORTUNITIES AND METHODS TO DELIVER CARE IN-PLACE WHERE SENIORS LIVE (AND TO DO SO IN A COST-EFFECTIVE, SUSTAINABLE MANNER). THROUGHOUT 2021, THE INSTITUTE ADVANCED ITS VALUE-BASED CARE HOME-BASED ACUTE CARE LEARNING AND ACTION NETWORK (VBC HOMELAN) COLLABORATIVE. THIS COLLABORATIVE IS A "HANDS ON" RESEARCH INITIATIVE THAT SUPPORTS THE ADVANCEMENT AND FINANCIAL SUSTAINABILITY OF HOME-BASED CARE PROGRAMS (MOST LED BY HOSPITALS) CENTERED ON PROACTIVE PATIENT ENGAGEMENT AND AGILE RESPONSES TO UNPLANNED ACUTE EVENTS.

COST OF HEALTHCAREOLDER ADULTS IN AMERICA (AND INDEED ALL INDIVIDUALS RESIDING IN THIS NATION) CONTINUE TO FEEL THE ECONOMIC BURDEN OF WHAT ARE AMONG THE HIGHEST HEALTHCARE COSTS IN THE WORLD. HIGH HEALTHCARE COSTS THREATEN FINANCIAL SECURITY, CURB PATIENT ACCESS, AND CROWD OUT SPENDING IN OTHER IMPORTANT ECONOMIC SECTORS SUCH AS EDUCATION AND SOCIAL SERVICES. THE GARY AND MARY WEST HEALTH INSTITUTE (WHI) REMAINS COMMITTED TO PLAYING AN IMPORTANT ROLE IN CONDUCTING APPLIED MEDICAL RESEARCH TO HELP PROVIDE UNBIASED AND RELIABLE DATA AND FINDINGS THAT ENABLE STAKEHOLDERS IN THE US HEALTH SYSTEM CHART A COURSE TO HEALTHCARE THAT IS MORE AFFORDABLE AND ULTIMATELY A BETTER VALUE FOR OLDER ADULTS IN AMERICA.THE WEST HEALTH INSTITUTE'S AREAS OF FOCUS IN ADDRESSING THE COST OF HEALTHCARE OVER THE PAST YEAR HAVE BEEN CENTERED AROUND CONDUCTING RESEARCH AND SHARING STATISTICS THAT CAN BE USED IN RAISING AWARENESS ABOUT THE SIZE AND URGENCY OF THIS ISSUE, LOWERING PRESCRIPTION DRUG PRICES, AND INCREASING PRICE TRANSPARENCY WITH A GOAL OF HIGHLIGHTING, AND EVENTUALLY REDUCING, OUT-OF-CONTROL HEALTHCARE SERVICE PRICING.GENERATE DATA THAT HIGHLIGHTS TO THE NATURE AND MAGNITUDE OF THE HEALTH SPENDING CRISIS TO FOCUS THE ATTENTION OF POLICYMAKERS, ADMINISTRATORS, AND THE GENERAL PUBLIC ON THE HEALTHCARE CRISIS, WHI UNDERTOOK A VARIETY OF STRUCTURED RESEARCH THAT WAS MADE WIDELY AVAILABLE IN 2021. OVER THE COURSE OF THE YEAR, WHI RELEASED FIVE HIGHLY SUCCESSFUL NATIONAL POLLS IN PARTNERSHIP WITH GALLUP. KEY FINDINGS PICKED UP BY MEDIA INCLUDED: MOST AMERICANS RANK REDUCING THE COST OF CARE AS A HIGH PRIORITY; AN ESTIMATED 46 MILLION CANNOT AFFORD NEEDED CARE TODAY; AND ONE IN SIX WORKERS ARE STAYING IN UNWANTED JOBS FOR HEALTH BENEFITS. THE GALLUP WORK ALSO INCLUDED THREE NATIONAL WEBINARS WITH WHICH SHARED OUR POLLING RESULTS. FINALLY, WE CLOSED THE YEAR BY PUBLISHING A LANDMARK 2021 "HEALTHCARE IN AMERICA REPORT," WHICH SHARED DATA THAT CHARACTERIZED THE GREAT INCREASE IN BURDEN OF HEALTHCARE COSTS AND THE GROWING WORRY ABOUT HEALTHCARE COSTS AMID COVID-19. THE REPORT WAS COVERED BY OVER 150 MEDIA OUTLETS.ADVANCE RESEARCH HELPING TO UNDERSTAND HOW DRUG COSTS MAY BE LOWERED; LEVERAGE DATA SCIENCE TO ILLUSTRATE PRICING DISPARITIES IN HEALTH SERVICESWHI WAS ABLE TO USE ITS DATA SCIENCE RESEARCH TEAM TO ANALYZE LARGE DATA SETS IN SUPPORT OF HYPOTHESES AROUND PRICE ISSUES IN BOTH DRUGS AND HEALTH SERVICES. FOR EXAMPLE, WHI DATA SCIENCE SUPPORT AND GUIDANCE WERE KEY TO A PUBLICATION IN JAMA OPEN, ESTIMATING SAVINGS FORM REFORMING MEDICARE REIMBURSEMENT POLICIES FOR BIOSIMILAR PRODUCTS, (GENERATING A HIGHLY FAVORABLE EDITORIAL COMMENT PUBLISHED ALONGSIDE THE ARTICLE). ADDITIONALLY, IN 2021, WHI ANALYZED LARGE AMOUNTS OF COMMERCIAL INSURER DATA VIA AN AGREEMENT WITH THE HEALTHCARE COST INSTITUTE (HCCI) TO SHOW THE INCONSISTENT AND EXTREMELY HIGH PRICES THAT MANY PROVIDERS CHARGE, HIGHLIGHTING THAT MARKET FAILURES MAY EXIST IN THE U.S. HEALTHCARE SYSTEM. RESEARCH AND DATA SUPPORT FOR THE CALIFORNIA MASTER PLAN FOR AGINGTHE MASTER PLAN FOR AGING (MPA) IN CALIFORNIA IS A BLUEPRINT FOR STATE AND LOCAL GOVERNMENT, THE PRIVATE SECTOR, AND PHILANTHROPY TO PREPARE THE STATE FOR THE PROJECTED DEMOGRAPHIC CHANGES AND AMPLIFY CALIFORNIA'S LEADERSHIP IN AGING, DISABILITY, AND EQUITY. THE URGENCY TO COMPLETE AND BEGIN IMPLEMENTATION OF THE MASTER PLAN WAS MAGNIFIED BY THE ONSET OF COVID-19, WHICH EXPOSED PERSISTENT AND SYSTEMIC INEQUITIES THAT DISPROPORTIONATELY IMPACTED OLDER CALIFORNIANS, PEOPLE WITH DISABILITIES AND COMMUNITIES OF COLOR. OVER THE COURSE OF 2021, WHI HAD THE OPPORTUNITY TO CONTINUE TO PROVIDE SCIENCE-DRIVEN INPUT INTO THE MPA IN A NUMBER OF WAYS. FINDINGS FROM THE GERIATRIC EMERGENCY DEPARTMENT (GED) RESEARCH WORKSTREAM WAS SHARED WITH POLICYMAKERS AND HAS RESULTED IN GEDS BEING SPECIFICALLY CALLED OUT IN THE MPA AS A MECHANISM FOR ONGOING DATA COLLECTION, AMONG OTHER FUNCTIONS. ADDITIONALLY, THE INSTITUTE HAS TAKEN A LEADING ROLE IN THE DEVELOPMENT OF THE DATA DASHBOARD FOR AGING, WHICH TRACKS THE MASTER PLAN'S TARGETS CURRENTLY AND OVER TEN YEARS. THE DATA DASHBOARD WAS CO-DEVELOPED BY THE CALIFORNIA DEPARTMENTS OF AGING AND PUBLIC HEALTH AND THE WEST HEALTH INSTITUTE AND SHOWCASES HOW RESEARCH AND DATA CAN BE USED TO BOTH INFORM AND EVALUATE POLICY DECISIONS AT A MACRO LEVEL.