Journal of Gerontological Nursing

AGS Update 

A Case Study in Moving From Research to Practice: AGS CoCare: Ortho™

Laurie G. Jacobs, MD, AGSF

Abstract

When you read the pages of a periodical like the Journal of Gerontological Nursing (JGN), it can be easy to lose yourself—in the most pleasant sense possible—in the research that informs our field. Indeed, the principles and practices we teach today started out as what you see here: ideas and novel suggestions written and reviewed by peers in the hope that, one day, they might move from being “novel” to becoming best-practice routines. What a compelling transition when you think about the trajectory of health care—one we should celebrate more often when we actually get to see it in action. In many respects, I think the American Geriatrics Society's (AGS; 2018) work on AGS CoCare: Ortho—our newest program to help health systems integrate geriatrics and orthopedic expertise for older adults hospitalized with hip fractures—offers a compelling case in point.

With $1.4 million in recently renewed support from The John A. Hartford Foundation—and now with the launch of a new website, ortho.agscocare.org—AGS CoCare: Ortho already has a solid legacy as one of our “best-practice routines” (Anderson & Wolfe, 2013; Bateman et al., 2012; Della Rocca et al., 2013; Friedman, Mendelson, Kates, & McCann, 2008; Kates et al., 2010). Since launching the initiative in 2017, the AGS CoCare: Ortho staff have been hard at work developing program offerings with the Principal Investigator Nancy Lundebjerg, MPA, and project leads Daniel Mendelson, MD, FACP, CMD, AGSF; Richard Besdine, MD; Lynn McNicoll, MD, FRCPC, AGSF; Stefan Gravenstein, MD, MPH; and Lynn Spragens, MBA. This year alone, the AGS CoCare: Ortho team began providing consultations and assistance to pilot sites at Northwell Health (NY), and to early adopter sites at Penn State Health (PA), the University of California San Francisco (CA), the University of Nebraska (NE), and the University of Rochester Strong Memorial Hospital (NY).

Part of that progress is practical—and a testament to the interprofessional collaborations that make geriatrics unique. AGS CoCare: Ortho offers a tangible resource for institutions interested in implementing a geriatrics–orthopedics co-management program in which geriatrics professionals or specially trained co-managers work with orthopedic surgeons to coordinate and improve the perioperative care of older adults with hip fractures. An institutional subscription to AGS CoCare: Ortho provides an institution's staff with access to a vast portfolio of tools and resources, including an online educational curriculum with credit for continuing medical education, as well as several other tools included on the AGS CoCare: Ortho site:

These are important, practical tools—but, again, we cannot lose sight of where they originated: geriatrics-informed research. AGS CoCare: Ortho incorporates a well-established geriatrics approach to care as soon as possible after an older adult enters the hospital for a hip fracture (Anderson & Wolfe, 2013; Bateman et al., 2012; Della Rocca et al., 2013; Friedman et al., 2008; Kates et al., 2010). The seeds of that research-informed idea have since helped identify and reduce the risk for harmful events ranging from falls and delirium to infections (Della Rocca et al., 2013; Friedman et al., 2008; Kates et al., 2010). The model has been shown to improve length of stay, readmissions, and risk for most complications, while also increasing an older adult's chances of going home directly from the hospital, which can lead to improved function and prolonged independence (Della Rocca et al., 2013; Friedman et al., 2008; Kates et al., 2010).

I offer AGS CoCare: Ortho as a case in point for two compelling reasons. First (practically), it may serve as a fruitful model for many nurses, physicians, physician assistants, pharmacists, social workers, and others looking for concrete solutions to a challenge such as hip fractures, which already lead…

When you read the pages of a periodical like the Journal of Gerontological Nursing (JGN), it can be easy to lose yourself—in the most pleasant sense possible—in the research that informs our field. Indeed, the principles and practices we teach today started out as what you see here: ideas and novel suggestions written and reviewed by peers in the hope that, one day, they might move from being “novel” to becoming best-practice routines. What a compelling transition when you think about the trajectory of health care—one we should celebrate more often when we actually get to see it in action. In many respects, I think the American Geriatrics Society's (AGS; 2018) work on AGS CoCare: Ortho—our newest program to help health systems integrate geriatrics and orthopedic expertise for older adults hospitalized with hip fractures—offers a compelling case in point.

With $1.4 million in recently renewed support from The John A. Hartford Foundation—and now with the launch of a new website, ortho.agscocare.org—AGS CoCare: Ortho already has a solid legacy as one of our “best-practice routines” (Anderson & Wolfe, 2013; Bateman et al., 2012; Della Rocca et al., 2013; Friedman, Mendelson, Kates, & McCann, 2008; Kates et al., 2010). Since launching the initiative in 2017, the AGS CoCare: Ortho staff have been hard at work developing program offerings with the Principal Investigator Nancy Lundebjerg, MPA, and project leads Daniel Mendelson, MD, FACP, CMD, AGSF; Richard Besdine, MD; Lynn McNicoll, MD, FRCPC, AGSF; Stefan Gravenstein, MD, MPH; and Lynn Spragens, MBA. This year alone, the AGS CoCare: Ortho team began providing consultations and assistance to pilot sites at Northwell Health (NY), and to early adopter sites at Penn State Health (PA), the University of California San Francisco (CA), the University of Nebraska (NE), and the University of Rochester Strong Memorial Hospital (NY).

Part of that progress is practical—and a testament to the interprofessional collaborations that make geriatrics unique. AGS CoCare: Ortho offers a tangible resource for institutions interested in implementing a geriatrics–orthopedics co-management program in which geriatrics professionals or specially trained co-managers work with orthopedic surgeons to coordinate and improve the perioperative care of older adults with hip fractures. An institutional subscription to AGS CoCare: Ortho provides an institution's staff with access to a vast portfolio of tools and resources, including an online educational curriculum with credit for continuing medical education, as well as several other tools included on the AGS CoCare: Ortho site:

  • A 34-module online educational curriculum with accompanying audio companions.
  • An online forum for sites to network and learn from one another.
  • Online coaching and consultation as participants gear up to adopt the AGS CoCare: Ortho model.
  • An implementation toolkit with products, templates, and resources to guide hospitals and health systems through the planning and implementation phases of geriatrics–orthopedics co-management.
  • An AGS CoCare: Ortho Co-Manager Certification Program.

These are important, practical tools—but, again, we cannot lose sight of where they originated: geriatrics-informed research. AGS CoCare: Ortho incorporates a well-established geriatrics approach to care as soon as possible after an older adult enters the hospital for a hip fracture (Anderson & Wolfe, 2013; Bateman et al., 2012; Della Rocca et al., 2013; Friedman et al., 2008; Kates et al., 2010). The seeds of that research-informed idea have since helped identify and reduce the risk for harmful events ranging from falls and delirium to infections (Della Rocca et al., 2013; Friedman et al., 2008; Kates et al., 2010). The model has been shown to improve length of stay, readmissions, and risk for most complications, while also increasing an older adult's chances of going home directly from the hospital, which can lead to improved function and prolonged independence (Della Rocca et al., 2013; Friedman et al., 2008; Kates et al., 2010).

I offer AGS CoCare: Ortho as a case in point for two compelling reasons. First (practically), it may serve as a fruitful model for many nurses, physicians, physician assistants, pharmacists, social workers, and others looking for concrete solutions to a challenge such as hip fractures, which already lead to hospitalizations for more than 260,000 older adults annually (Centers for Disease Control and Prevention, 2016). If you are interested in learning more about adopting AGS CoCare: Ortho, you can contact Deena Sandos at 212-308-1414 or dsandos@americangeriatrics.org for more details.

Second, I hope a platform like AGS CoCare: Ortho offers inspiration for continuing not only to research geriatrics principles but also to read about them as they unfold on the pages of periodicals like JGN. The bold new ideas that will effect change in our health systems are taking shape right now, right here. And that is certainly reason enough to get lost—in the most pleasant sense possible—in the research that informs our field.

Laurie G. Jacobs, MD, AGSF

President

American Geriatrics Society

References

  • American Geriatrics Society. (2018). AGS CoCare: Ortho. Retrieved from https://www.americangeriatrics.org/programs/agscocare-orthotm
  • Anderson, M. & Wolfe, B. (2013). How should patients with acute hip fractures be managed perioperatively. Retrieved from https://www.the-hospitalist.org/hospitalist/article/125565/how-should-patients-acute-hip-fractures-be-managed-perioperatively
  • Bateman, L., Vuppala, S., Porada, P., Carter, W., Baijnath, C., Burman, K. & Hargus, J. (2012). Medical management in the acute hip fracture patient: A comprehensive review for the internist. The Ochsner Journal, 12, 101–110.
  • Centers for Disease Control and Prevention. (2016). Hip fractures among older adults. Retrieved from https://www.cdc.gov/homeandrecreationalsafety/falls/adulthipfx.html
  • Della Rocca, G.J., Moylan, K.C., Crist, B.D., Volgas, D.A., Stannard, J.P. & Mehr, D.R. (2013). Comanagement of geriatric patients with hip fractures: A retrospective, controlled, cohort study. Geriatric Orthopaedic Surgery & Rehabilitation, 4, 10–15. doi:10.1177/2151458513495238 [CrossRef]
  • Friedman, S.M., Mendelson, D.A., Kates, S.L. & McCann, R.M. (2008). Geriatric co-management of proximal femur fractures: Total quality management and protocol-driven care result in better outcomes for a frail patient population. Journal of the American Geriatrics Society, 56, 1349–1356. doi:10.1111/j.1532-5415.2008.01770.x [CrossRef]
  • Kates, S.L., Blake, D., Bingham, K.W., Kates, O.S., Mendelson, D.A. & Friedman, S.M. (2010). Comparison of an organized geriatric fracture program to United States government data. Geriatric Orthopaedic Surgery & Rehabilitation, 1, 15–21. doi:10.1177/2151458510382231 [CrossRef]
Authors

The author has disclosed no potential conflicts of interest, financial or otherwise.

Copyright © 2018 American Geriatrics Society.

10.3928/00989134-20180808-09

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