As Massachusetts launches new initiatives to improve primary care in the Commonwealth, PCORI (the Patient Centered Outcomes Research Institute) has awarded Mass General Brigham (MGB) and Brandeis University a $25M contract to test two approaches to enhancing the delivery of geriatric care in the primary care setting. This six-year award follows a recently completed feasibility phase and is co-led by Dr. Christine Ritchie, a geriatrician and palliative care physician at MGB, and Dr. Jennifer Perloff at Brandeis.
The study data center will be led at the Schneider Institutes for Health Policy and Research at Brandeis by Drs. Jennifer Perloff and Karen Donelan. SPIRE (Supporting Practices in Respecting Elders) will compare outcomes including patient experience, hospitalizations and caregiver distress in two primary care models. Half of the practices will implement more optimal use of Medicare annual wellness visits, the others a nursing and social work team-based care program called the Geriatric Resources and Assessment for the Care of Elders (GRACE) program. The GRACE program offers a home assessment and elder-focused assessments of issues such as nutrition, cognition, home safety, fall risks and more. These teams work with the primary care team, pharmacists and geriatric specialists to make personal care plans.
“Primary care clinicians struggle to care for older adults with complex care needs in visits that are just too short, and older patients and families are often frustrated and confused by multiple appointments, medications and diagnoses. The right team approach can save time, money and caregiver stress,” says Donelan, Stuart H. Altman Chair in U.S. Health Policy and Co-Director of the Schneider Institutes. “Our ultimate goal is to help health systems better meet the needs of older adults they serve” says Ritchie, “especially those with multiple health challenges.”
The study will involve 2,880 older patients with complex health needs and their caregivers who are served by four health systems and accountable care organizations in Massachusetts, Connecticut, North Carolina and Texas. 16 of the 32 practices are in Massachusetts within the MGB system. The study engages with the system leaders, clinical teams, patients and families as research partners throughout the next five years.
“It is so important to view the impact of health service changes on patients, family and health teams,” says Perloff, who brings several years of expertise analyzing Accountable Care Organization initiatives and nurse practitioner-provided care. “This study breaks new ground by rigorously testing age-friendly, team-based care for older adults in real-world primary care practices nationwide and locally here in Massachusetts where policymakers are trying to foster improved access to primary care.”
For more information, visit www.spire-study.org.