A Novel Intervention to Identify and Report Suspected Abuse in Older, Primary Care Patients.

BACKGROUND: Previous research has identified several barriers faced by clinicians in detecting and reporting elder abuse, such as lack of knowledge about the process to report suspected cases of abuse and lack of access to experts to consult with. A novel intervention was designed and tested that embedded two Adult Protective Services (APS) specialists in a healthcare system operating primary care clinics serving a large Medicare population. OBJECTIVES: To examine the types of roles the APS specialists played in the healthcare system and the number and types of cases of suspected abuse among older patients that clinicians consulted them about and reported to APS. DESIGN: Cross-sectional, exploratory study. SETTING: Primary care clinics in five regions of Texas. PARTICIPANTS: Older patients of primary care clinics. INTERVENTION: APS specialists and project staff trained clinicians on how to identify and report abuse, neglect, and exploitation among older patients. The specialists were also available in person or by telephone and email to consult with clinicians about patients suspected of being abused by others or being self-neglecting. MEASUREMENTS: Data were obtained by conducting semistructured telephone interviews with APS specialists; and from APS specialists' written documentation/notes of consultations with clinicians regarding suspicion of abuse among patients and whether a report to APS was warranted. RESULTS: The APS specialists trained clinicians on abuse, consulted with clinicians, and served as a liaison between the healthcare system and APS. During the project, clinicians reported 529 older patients to APS, and 386 patients received one or more services documented by APS at case closure. These cases involved 902 allegations of various types of abuse, of which the most common was self-neglect (617 or 68%). CONCLUSION: Embedding APS specialists in a large healthcare system led to clinicians' increased awareness of the importance of identifying and reporting elder abuse, particularly self-neglect. J Am Geriatr Soc 68:1748-1754, 2020.

Building academic capacity through statewide partnerships.

In 2008, Texas was challenged by the Center to Champion Nursing in America, an initiative of the Robert Wood Johnson Foundation and AARP, to join a nationwide campaign for action to increase nursing education capacity. This article describes how one state created academic partnerships to achieve capacity building and strengthened relationships and commitments to invest in nursing education. Three year outcomes include a) the creation of a statewide team to address nursing education capacity, b) progress toward doubling the number of nursing graduates from the state's schools of nursing, c) strengthening and emphasizing retention efforts across the state, d) regionalization, including implementation of a $1 million grant and e) transitioning the statewide team to a broader focus and commitment to the Initiative on the Future of Nursing via the formation of a Regional Action Coalition.

An evaluation of the Ontario Rapid Risk Factor Surveillance System.

BACKGROUND: The Rapid Risk Factor Surveillance System (RRFSS) is an ongoing population health survey conducted by a collaborating group of Ontario public health units. This formative evaluation examined the process effectiveness, collaboration, utility and cost-effectiveness of RRFSS during its first year of operation. METHODS: An Evaluation Framework was developed with reference to guidelines for evaluation of surveillance systems developed by the World Health Organization and the U.S. Centers for Disease Control and Prevention. The study focussed on evaluable performance areas in a young surveillance system and on information needed to inform stakeholder decisions about future participation and improvement. Data were collected through surveys and interviews of key informants in participating health units, non-participating health units, the survey research house, and the provincial health ministry. RESULTS: Findings documented early use and dissemination of RRFSS data in health units after less than a year of surveillance system operation, stakeholder perceptions overall of data impact and value, and satisfaction with system functioning. Challenges to effectiveness were documented concerning data analysis, barriers to data use, and sustainability. Performance improvement strategies were identified for survey implementation and supports, data use, system participation, and reduced costs. CONCLUSION: In its first year, RRFSS was an effective collaborative method to collect population data for public health program planning and evaluation. The evaluation provided valuable information on use, functioning, effectiveness, strategic issues and areas for improvement in a young surveillance system, created opportunities for stakeholder input into evaluation and planning, and provided a baseline for future evaluations.