Twelve years ago the geriatrics physicians at Aurora Health Care in Wisconsin became frustrated with the need to provide safe care to vulnerable older hospitalized patients.  We developed and implemented an evidence-based model of care, Acute Care for Elders (ACE). Disseminating the ACE model to multiple med-surgical units and to each of the 15 hospitals within our health system initially proved challenging.  We found that using health information technology greatly helped us to spread this model of care.

We observed that health care workers were entering information into the electronic record of every patient, but that no one was systematically using the information.  The key component of the ACE model is the ACE Tracker report — a real-time checklist report of key clinical indicators for all of the older patients on a med-surgical unit.  The report is available on a tab in the electronic medical record of each hospitalized patient in every hospital, and is generated without any additional work from the nursing staff.

Use of the ACE Tracker report kept interdisciplinary teams focused on the risks for developing common geriatric problems (see abstract).  It is used by geriatricians and clinical nurse specialists during hospital rounds to provide a safety check on risks for geriatric syndromes.  It is also used by nurses from the Aurora Visiting Association of Wisconsin to assist in identifying older patients who may benefit from homecare.  Finally, the ACE Tracker report allows geriatricians to review the care of older patients at rural hospitals without a geriatrician on staff during weekly conference calls.

It is important to note that the ACE Tracker tool must be used by the team and does not replace the team meetings. The software report requires interpretation of multiple measures by a geriatrician or clinical nurse specialist, and does not tell the team/provider what to do.  Finally, as with any tool, the ACE Tracker is only as good as the data from which it harvests.

The ACE Tracker has helped us to bring Acute Care for Elders to a large population of seniors in Wisconsin.  Fourteen of Aurora Health Care’s 15 hospitals now have ACE programs, and improvement has been demonstrated using the ACE model.  From 2007 to 2010, Aurora was able to decrease use of urinary catheters (28% vs. 22.1%), provide early evaluation of the patients’ physical therapy (60.4% vs. 69.6%), and provide early assessment of their social service needs (67.3% vs. 73.7%) (see abstract).   Other health systems have adapted the ACE Tracker to identify vulnerable older patients (Peace Health Care, Eugene, OR, and University of Wisconsin Hospitals, Madison, WI).

Lessons learned. We now include health information technology leaders on our interdisciplinary teams as we develop and disseminate geriatrics models of care.  Our health information technology tools don’t have to be perfect before we launch them.  An advisory team helps to guide the continued improvement of consecutive versions of the tools.

Next steps. We hope to implement real-time tracking tools in multiple settings:  homecare, clinics, as well as hospitals.  We anticipate the need to identify patients at risk for geriatric syndromes in the hospital and communicate that risk in the electronic medical record when the patient visits their doctor, after the hospitalization.  We also will determine if the ACE Tracker improves health outcomes.  Finally, we will help other health systems to implement Acute Care for Elders by assisting their development of software to identify vulnerable elders.

Is your agency using or planning to use information technology to improve care for your older patients?  Tell us about it in the comments below. Also, feel free to ask questions about the ACE Tracker.

Michael Malone, MD
Aurora Health Care