1. 1 Mental Health & Older Adults: The Wisconsin Geriatric Psychiatry Initiative (WGPI) & “Star” Method Linda Buel RN May 8, 2009

2. 2 Overview The public health crisis The public health crisis Introduction of WGPI & the Star method Introduction of WGPI & the Star method Early results Early results Outcomes measurement plan Outcomes measurement plan Reach Reach

3. Issues – now and in 2030 Population aged 65 and older will increase from 20 million in 1970 to 69.4 million Older adults with mental illness will increase from 4 million in 1970 to 15 million Ratio of Geropsychiatrists to older adults - 1:11,451 to 1:20,195 Ratio of Geropsychiatrists to older adults - 1:11,451 to 1:20,195 Jeste, Alexopoulus, Bartels, et al., 1999 Association of Directors of Geriatric Academic Programs' "Status of Geriatric Workforce Study"

4. Consequences compromised quality of life increased morbidity and mortality- increased service visits, increased burden to medical care providers, and heightened annual costs of care. premature nursing home placement preventable hospitalizations Bartels Stephen J, Michael A. Smyer, Mental Disorders of Aging: An Emerging Public Health Crisis?

5. 5 Wisconsin Geriatric Psychiatry Initiative: Addressing Complexity in the Face of Scarcity Goal: Goal: to enhance the delivery of mental health services to older adults in Wisconsin to enhance the delivery of mental health services to older adults in Wisconsin Methods: Methods: indirect care via case-based consultative teaching sessions, using the Star Method indirect care via case-based consultative teaching sessions, using the Star Method more widely disseminate principles of geriatric psychiatry to different groups of providers: more widely disseminate principles of geriatric psychiatry to different groups of providers: health care: medical and psychiatric health care: medical and psychiatric long-term care long-term care aging network aging network network weaving: shaping an infrastructure via the strength of weak ties network weaving: shaping an infrastructure via the strength of weak ties Dr. Tim Howell

6. 6 Determinants of Health ( Evans and Stoddart, 1990)

7. 7 Understanding & Addressing Geriatric Problems: The Wisconsin “Star” Method Symptom, Problem Medication Issues Social Issues Personal Issues (Personality) Psychiatric Issues Medical Issues

8. 8 Early Results - 1 Community Health Partnership report Patient Patient Dates of Service Dates of Service Date of consultation Date of consultation Activity before Activity before Activity after Activity after

9. Early Results - 2 Community Health Partnership report Patient Issues Team Issues Organization Issues CT Session results Changes after consult

10. 10 Outcomes BEFORE & AFTER SESSION Specific to this case how would you rate (the team) in the following: -2012 Insight Enthusiasm Clarity Motivation Understanding Professional comfort re: how team is working Professional comfort re: this current situation Level of hope about this member Level of hope about his situation

11. 11 Outcomes To what extent do you agree that the results of the Star Method affect patients': disagree strongly disagree slightly neither agree or disagree agree slightly agree strongly quality of life self-reported health status physical function emotional function

12. 12 Reach Milwaukee: CCO (PACE/Partnership/Family Care), Aurora Geriatrics, & ALM (CBRF) Madison: Care Wisconsin, Family Services Eau Claire: CHP (Partnership/Family Care) AGS website: www.americangeriatrics.org San Antonio & Galveston TX (U Texas), Columbia MO (U Missouri), Rochester MN (Mayo), Baltimore MD (Johns Hopkins), & Milwaukee (MCW): geriatric medicine fellowship programs (by speaker phone from Aurora Geriatrics) Dr. Tim Howell

13. 13 Acknowledgements Tim Howell, MD, MA; WGPI Tim Howell, MD, MA; WGPI Geriatric Psychiatrist Associate Professor, UW Dept of Psychiatry Cathy Swanson-Hayes - DHS Cathy Swanson-Hayes - DHS Other members of the WGPI coalition Other members of the WGPI coalition University of Wisconsin Hospital & Clinics University of Wisconsin Hospital & Clinics