Improving older adults' telehealth through a novel community-academic partnership: Preliminary data.

BACKGROUND: The COVID-19 pandemic increased the use of telehealth, which posed unique challenges for the provision of care to older adults who face numerous barriers to accessing and using technology. To improve older adults' online health-related abilities, the UCSF Geriatrics Workforce Enhancement Program (UCSF-GWEP) partnered with Little Brothers Friends of the Elderly-San Francisco (LBFE-SF) to develop a model telehealth training intervention. METHODS: LBFE-SF recruited older adults from their members with wi-fi and paired each one with a new device and volunteer trainer to cover seven lessons and four key tasks (emailing providers, video visits, accessing health information, and using patient portals). Older adults completed surveys to self-assess their skill level after training, and their confidence before, immediately after, and 3 months post training. A subset of trainees were also interviewed about their program goals and experiences. UCSF-GWEP conducted statistical analyses of survey data, and coded interview transcripts to identify aspects of the model supportive to learning and success. RESULTS: Of 43 participants, 31 completed training. Their median age was 75; 48% were non-white; 45% had no more than a high school education; and 63% reported yearly income below U.S. $20,000. Three months after completing the program, more than 50% of trainees reported that they needed little or no help performing all four key tasks, and confidence with video visits, online searches, and patient portals showed significant improvement. Additionally, in interviews participants reported improved health, social benefits, and explained that learning was facilitated by self-pacing, repetition, and longitudinal support from volunteer trainers. CONCLUSIONS: Older adults with various barriers to learning technology showed online independence and increased confidence with some telehealth tasks after a novel training intervention. Key characteristics of the model included a tablet device, one-on-one longitudinal support from volunteers, comprehensive learning materials, and community-academic partnership.

Impact of a selective narrow network with comprehensive patient navigation on access, utilization, expenditures, and enrollee experiences.

OBJECTIVE: To examine the effect of enrollee switching from a broad-network accountable care organization (ACO) health maintenance organization (HMO) to a "high performance" ACO-HMO with a selective narrow network and comprehensive patient navigation system on access, utilization, expenditures, and enrollee experiences. DATA SOURCES: Secondary administrative data were obtained for 2016-2020, and primary interview and survey data in 2021. STUDY DESIGN: Fixed-effects instrumental variable analyses of administrative data and regression analyses of survey data. Outcomes included access, utilization, expenditures, and enrollee experience. Background information was gathered via interviews. DATA COLLECTION/EXTRACTION METHODS: We obtained medical expenditure/enrollment and access data on continuously enrolled members in a broad-network ACO-HMO (n = 24,555), a subset of those who switched to a high-performance ACO-HMO in 2018 (n = 7664); interviews of organizational leaders (n = 13); and an enrollee survey (n = 512). PRINCIPAL FINDINGS: Health care effectiveness data and information Set (HEDIS) access measures were not different across plans. However, annual utilization dropped by 15.5 percentage points (95% CI: 18.1, 12.9) more in the high-performance ACO-HMO, with relative annual expenditures declining by $1251 (95% CI: $1461, $1042) per person per year. High-performance ACO-HMO enrollees were 10.1 percentage points (95% CI 0.001, 0.201) more likely to access primary care usually or always as soon as needed and 11.2 percentage points (95% CI 0.007, 0.217) more likely to access specialty care usually or always as soon as needed. Plan satisfaction was 7.1 percentage points (95% CI: -0.001, 0.138) higher in the high-performance ACO-HMO. Interviewees noted the comprehensive patient navigation system was designed to ensure patients remained in the narrow network to receive care. CONCLUSIONS: ACO and HMO contracts with selective narrow networks supported by comprehensive patient navigation can reduce expenditures and improve specialty access and patient satisfaction compared to broad-network plans that lack these features. Payers should consider implementing narrow networks with comprehensive support systems.

Evaluating Interorganizational Collaborations: Lessons Learned from Five California Geriatric Workforce Enhancement Programs.

BACKGROUND: Five Geriatric Workforce Enhancement Programs (GWEPs) in California, funded for 4 years, worked collaboratively across different organizations to provide education on aging issues and/or training to enhance services for older adults. OBJECTIVES: To investigate characteristics of the collaborations that were associated with perceptions and experiences of success for participating organizations. METHODS: A survey distributed to 37 organizations participating in 5 GWEPs measured the correlation of resources and dimensions of collaboration with perceived sense of success of the collaborations. Interviews with 30 representatives of the participating organizations collected information about perceived barriers, impact, and satisfaction with the collaborations. RESULTS: Overall perceptions of interorganizational collaboration success were associated with provision of physical resources and four key measures of collaboration (governance, administration, mutuality, and norms/trust). Barriers to success were described in terms of organization functioning and resources. Strong communication appeared as a facilitator of success, and reciprocity was described as a key experience of satisfaction. CONCLUSIONS: This study highlights the positive effects of shared goals, the experience of reciprocity, and communication during interorganizational collaborations. It also notes the negative effects of having inadequate resources and organizational dysfunction.

Adult Protective Services Training: Insights from California Caseworkers.

Adult Protective Services (APS) training is critical to the mission of APS in supporting the workforce, but not much is known from caseworkers' perspectives. To learn more, 63 caseworkers in five California counties, from urban, suburban, and rural areas, participated in focus groups. Discussion was organized around three open-ended questions regarding implementation of the National Adult Protective Services Association (NAPSA) training content in practice: (1) What trainings have changed your practice and how? (2) How could training be changed to make it easier to implement? (3) What characteristics of your work environment interfere with implementation of learning? Through iterative reading and review of focus group transcripts, four themes emerged: (1) motivations, (2) barriers, (3) facilitators, and (4) impact. Caseworkers also made recommendations to improve training for better implementation of concepts and skills. Caseworkers involved in this study were quick to assert the need for increased access to training, more sophisticated content, and experiential learning. Moreover, expanding and enhancing safety training was recommended, as was aligning training with local needs and policies. Since the NAPSA approved APS core competencies and advanced topics are also offered and used in other counties and states, considering how to improve training could benefit caseworkers nationwide.

"The More They Know, the Better Care They Can Give": Patient Perspectives on Measuring Functional Status in Primary Care.

BACKGROUND: Despite its importance to care and outcomes for older adults, functional status is seldom routinely measured in primary care. Understanding patient perspectives is necessary to develop effective, patient-centered approaches for measuring function, yet we know little about patient views on this topic. OBJECTIVE: To examine patient and caregiver perspectives on measuring activities of daily living (ADLs) and instrumental ADLs (IADLs). DESIGN: Qualitative study using semi-structured interviews. PARTICIPANTS: Twenty-eight patients aged 65 or older and five caregivers in primary care clinics at one Veterans Affairs Medical Center. APPROACH: We conducted interviews to elicit patient and caregiver perspectives on the importance of measuring function, including preferences for method of screening and assessment, wording of questions, and provider communication style. We analyzed interviews using qualitative thematic analysis. KEY RESULTS: We identified several themes related to measuring function in primary care. First, most participants reported that measuring function is part of quality, holistic care. However, a minority of participants noted that discussing function, especially IADLs, was not medically relevant. Second, in terms of preferences for measuring function, participants noted that interdisciplinary approaches to measuring function are optimal and that face-to-face assessment is most "intimate" and can prompt reflection on one's limitations. However, some participants indicated that self-assessment is less invasive than in-person assessment. Third, participants had varied preferences regarding communicating about function. Participants noted that asking about difficulty with activities versus need for help are distinct and complementary concepts and that providing context is essential when discussing sensitive topics such as functional decline. CONCLUSIONS: Most patients and caregivers reported that measuring function was important, preferred face-to-face assessment, and emphasized the importance of providing context when asking about function. These findings suggest that incorporating patient and caregiver preferences for measuring function can improve satisfaction and experience with functional assessment in primary care.

Healthy Young Adults: description and use of an innovative health insurance program.

PURPOSE: To evaluate enrollment patterns, healthcare use, and factors associated with enrollment in San Francisco's Healthy Young Adults (HYA) program, a comprehensive public health insurance program for young adults who age out of public insurance. METHODS: In a group of young adults who were all eligible for HYA, we compared demographic characteristics by enrollment status. Demographic information and use patterns were obtained for individuals who were continuously enrolled in HYA for 12 months. RESULTS: Nearly one quarter of eligible young adults enrolled in the program. Those who enrolled were more likely to have used vision or pharmacy services in the 2 years prior to enrollment, to be Asian, and to be from Chinese-speaking families (p < .001) than those who did not enroll. The large majority (80%) of young adults who enrolled in HYA had a primary care or dental visit during the 12-month study period. More than one third (40%) of enrollees used the prescription benefit, while much smaller percentages used radiology services, the emergency department or inpatient facilities. CONCLUSIONS: Young adults in the City and County of San Francisco who enrolled in HYA had high use rates. Ethnic disparities in enrollment indicate the need for targeted outreach. Adverse selection into the program, although present, was minimal. Local innovations are one way to address the problem of uninsurance in the United States, and HYA could be replicated elsewhere.