Communication: Taking care of Dementia patients across care settings

1. Communication: Taking care of Dementia patients across care settings IDND Presentation May 18th, 2010

2. What is: • Formed by Dr. Linda Stropes and Sandy Bammann, NP in 1988 and later joined by Bryon Miller, JD, NP as a Primary Care Practice specializing in Geriatrics • We are SNFist? Physicians: Linda Stropes, MD Larissa Dimitrov, MD Stephen Pennal, MD Patrice Yates, MD Jayne Croghan, MD Partner Physicians: James Ong, MD—Anderson, IN George Agapios, MD—Pendleton, IN David Dewar, MD—Anderson, IN Kelly Chambers, MD— Anderson, IN Tony Dowell, MD—Muncie, IN Techsin Ty, MD—Kokomo, IN Federico Salcedo, MD – Sellersburg, IN Hospital Partnerships: St. Vincent Hospital Community Health Network St. Francis Beech Grove Westview Hospital Kindred Hospital 10th Street (Coming Soon)

3. 1980’s Health Care SNF’s High LOS Low Acuity Hospital High LOS Low Acuity SNF’s PCP Stropes Hospital PCP PCP PCP

4. 1990’s Health Care Hospitalist SNF’s Decreasing LOS Increasing Acuity Hospital Decreasing LOS Increasing Acuity SNF’s PCP AHA Hospitalist Hospital PCP PCP PCP

5. 2000’s Health Care Hospitalist Hospital Low LOS Very High Acuity SNF’s Lower LOS Very High Acuity SNF’s PCP AHA Hospitalist Hospital PCP PCP Hospital Employed Physicians PCP

6. 2000’s Health Care Hospital Low LOS Very High Acuity SNF’s Decreasing LOS Very High Acuity EMR EMR Hospitalist SNF’s Hospital SNFist Transitions Hospitalist Hospital Employed Physicians

7. How big is the “Transitional” issue • 10% of NH residents arrive in the ED without any documentation • Essential patient information is typically missing in the other 90% • Reason for transfer (missing in 11% - 23% of transfers) • Baseline mental status (48% - 53%) • Current medications (24%) • Medication allergies (37%) • Code status (29%) • Name of on-call NH physician (33%) Slide and content provided by: Kevin Terrell, MD Wishard ER Director

8. What can you do?