Research at Summa

As America ages, there will be an increased need for physicians who have the training and clinical experience needed to treat older patients. It’s clear the U.S. is facing a serious shortage in the number of geriatricians with the skills and training required to effectively care for frail, complex older adult patients who have multiple chronic conditions.

There also are critical shortages of geropsychiatrists, geriatrics nurse practitioners, pharmacists and other professionals with certification in geriatrics.

Attracting sufficient numbers of potential healthcare professionals to the practice of geriatric medicine is a challenge. That’s why geriatric fellowship programs like the one offered by Summa Health System are so important.

Summa is one of a very few hospitals in the nation to receive multiple grants from the National Institutes of Health, the National Institute of Neurological Disorders and Stroke and the Agency for Healthcare Research and Quality. Obtaining funding and conducting research helps the Institute refine and implement programs and services that are vital to senior health.

Health Services Research and Education Institute (HSREI)
The Health Services Research and Education Institute (HSREI) was established at Summa Health System in January 1999 to provide the infrastructure and technical resources to:

• Promote collaborative research among physicians, residents, nurses, medical students, and community organizations across the continuum of care
• Develop and test interventions that promote clinical applications of evidence-based health care guidelines for chronic disease management

Current HSREI research studies and programs include:

• The STEPS Care Trial
• Elder abuse research
• The AD-Life Trial
• The ACE Unit
• ICARE Team
• Geriatric Fellowship Program
• Palliative Care Fellowship Program

Research

Strategies to Enhance Post-Stroke Care and Recovery: The STEPS Care Trial
In 2002, The National Institutes of Health (NIH) awarded a grant in the amount of $787,000 to Summa Health System for research in developing a model for post-stroke care management. Based on key concepts and processes learned from the Acute Care for Elders Project, in the STEPS CARE model, patients receive post-stroke care management involving a nurse care manager and an interdisciplinary team of physicians and other stroke experts.

Patients are visited in their home after discharge by a nurse care manager and a detailed assessment and individualized care plan is developed. In a pilot study done in 2001 with 96 patients, the results showed that the care management model improved risk factors for preventing another stroke and major indicators of stroke recovery.

Building on these preliminary findings, the NIH funded trial incorporates an improved care management intervention, improved standardized protocols, a larger sample of 380 post-stroke patients and more comprehensive follow-up. If successful, this model of care could begin to establish a national standard for post-stroke care.

Elder Abuse Research
In 2005, Summa Health System was awarded a replication grant for the Texas Elder Abuse and Mistreatment model funded by the Department of Justice. Both organizations recognized elder abuse, neglect and mistreatment could best be addressed with a comprehensive interdisciplinary approach. Adult Protective Services (APS) investigators identify challenging cases—these individuals receive comprehensive geriatric assessment in the CSH or in their own homes. The case is then reviewed by a team consisting of the APS investigator, APS supervisor, geriatrician, Center for Senior Health social worker, geriatrics advanced practice nurse, Area Agency on Aging representative, a Probate Court representative, police and a senior coordinator from the sheriff’s office to develop an appropriate action plan.

After Discharge Care Management of Low Income Frail Elderly: AD – Life Trial
In 2005, Summa’s Post Acute and Senior Health Services received a grant from the U.S. Department of Health and Human Services’ Agency for Health Research and Quality (AHRQ) to help Summa evaluate an innovative care management intervention for patients after they are discharged from the hospital. The focus of the grant is to determine whether a comprehensive team approach to medical care will improve the clinical and functional outcomes for vulnerable or ‘frail” older adults.

After hospitalization, older adults with chronic illnesses are particularly vulnerable to adverse outcomes such as functional decline, increased risk of needing nursing home care and a decreased quality of life. The risk is even greater for low-income older adults with multiple chronic illnesses who often have limited assistance for coping with post-discharge complications.

The goal of the After Discharge Care Management of Low Income Frail Elderly (AD-Life) Trial is to help healthcare systems across the nation change their emphasis from acute illness treatment to a chronic illness management model and measure the impact on healthcare utilization and cost effectiveness of such a model.

Acute Care for Elders (ACE) Unit
When an older adult is hospitalized, they often face challenges other patients may not face. Summa Health System’s Acute Care for Elders Unit (ACE) is a nationally recognized, state-of-the-art care model to improve hospital care for older adults. The ACE unit integrates every aspect of care needed to make sure patients are getting the specialized care they deserve.

Summa’s ACE Unit offers an innovative approach to care which is unique in the Akron area. The program also includes an online ACE Forum and an ACE Manual for health systems interested in developing a program.

ICARE
Summa has worked collaboratively in the creation of Interdisciplinary Consortium for Aging Research and Education (ICARE), a team that includes representatives from the area universities (University of Akron, Kent State University, NEOUCOM/COP) and the Area Agency on Aging who have come together to support research and education focused on aging.