Baylor College of Medicine's

Huffington Center on Aging

MacGregor Medical Associates Community Academic Partnership

Overview:

In Texas and throughout much of the U.S., the growth in managed care has been dramatic. The numbers of older adults who receive capitated health care through Medicare TEFRA risk contracts is growing by about 80,000 each month nationwide and is already more than IO% of all Medicare recipients. Managed care emphasizes the use of the primary care physicians assisted by a "full compliment" of allied health specialists, and services all focused on delivering more efficient care (Wagner, 1996). A national study done by Friedman and Kane (1993) found that only half of TEFRA HMO medical directors had hired at least one geriatrician and these individuals were employed for primary care and specialist consultation. Significantly, only 28& of these HMO geriatricians reported being fellowship trained with another 34% having earned this designation through examination (Certificate of Added Qualifications) and the remaining 4O% being self-identified based on their personal interests.

TCGEC staff will assess what the providers report they need to know in order to effectively treat their older patients. Education programs will then be tailored to individual needs and include a menu of computer-based learning modules (congestive heart failure, incontinence, osteoporosis, geroethics, and dementias are typical topics) linked from Huffington's Web site <www.hcoa.org> to MacGregor's intranet, MINE. Part of the "tailoring" will include meeting specific information needs with key papers and/or consensus guidelines and supporting that by consultation with MacGregor geriatricians and TCGEC staff.

To determine if the intervention has made a difference, this initiative's EPoM will track enrollees' educational performance outcomes through pretests and posttests, compare patient record databases focusing on practitioners' standards of care before and after the intervention, and evaluate the relationship of their clinical activities and information attained to reported outcomes of benefit to older patients.