Centralizing care for dementia patients
|Carolyn Clevenger directs the new Integrated mEmory Care Clinic, which is run by nurse practitioners.
Caring for a family member with dementia is complex and highly stressful. Consider the Alzheimer's patient who behaves erratically when his blood sugar level spikes or plummets in the course of a day. It's not up to the neurologist to manage the patient's diabetes. And the patient's primary care physician can't see him until next week.
The new Integrated mEmory Care Clinic aims to help in such cases by providing dementia and primary care services in one place. It is located within the Memory Disorders Clinic at 12 Executive Park. Both are part of the Emory Brain Health Center, which opened last year and is set to launch officially later this month. (Stay tuned for more details on this coming soon.)
The Integrated mEmory Care Clinic, which is run by nurse practitioners, is essentially a "medical home" for dementia patients, where nurse specialists provide high-quality continuity of care at low cost. It is the brainchild of the Nell Hodgson Woodruff School of Nursing and the Department of Neurology and is funded by $1 million gifts to each from two different anonymous donors. The Emory Palliative Care Center and the Division of General Medicine and Geriatrics also play significant roles at the clinic.
Clinic nurses are seeing their first cohort of patients from the Memory Disorders Clinic and plan to grow their patient base in waves, drawing next from throughout Emory Healthcare and then the general public. Patients must live no farther than an hour's drive away.
"We're just starting to develop a critical mass of patients," says Carolyn Clevenger, clinic director and nursing school faculty member. "That's going to take time. It will take us about three years to reach the break-even point."
The idea for the clinic evolved out of concern for patients and family members who must navigate getting to and from appointments with multiple providers and who need help in prioritizing numerous tests and treatments.
"One issue for families is looking at patient care through the prism of a dementia diagnosis," says Janet Cellar, a clinical nurse specialist in geriatric psychiatry and clinic project director. "Do you really need to be aggressive about services such as mammograms and colonoscopies when a patient is severely impaired?"
The team that Cellar co-leads provides expertise in several areas. They include NPs in geriatrics, neurology, geriatric psychiatry, and palliative care; a care coordinator RN; a clinical social worker; and four patient-family advisers. Physicians Allan Levey and Ihab Hajjar provide backup in cognitive neurology and geriatrics, respectively.
"Our goal is to see a patient within 24 hours of a request," says Cellar. "If a family caregiver calls in the morning, we can see the patient that same day. We're also on call 24/7, so the caregiver can reach one of us directly if they have an issue in the middle of the night."
The nurses recently saved a trip to the clinic for a dementia patient with a urinary tract infection. They coached her caregiver by phone on how to relieve symptoms with rehydration and checked back later to see how the patient was faring.
"What we've heard from patients and families is that they want to understand how dementia works and that we have a plan for dealing with it," says Clevenger. "We can't totally relieve the caregiver burden. But we can educate families about what to expect as the dementia progresses and how to deal with issues like UTIs, which can affect a patient's behavior. Having one place where providers understand how to deal with both dementia and primary care needs is a great service to families."—Pam Auchmutey
For appointments, call the Integrated mEmory Care Clinic at 404-712-6929.
Reasons behind Emory's top rank for grad student predoc fellowships
|Anita Corbett (biochemistry) directs writing courses for Emory graduate students.
Emory was cited recently for its topmost rank in the nation for its number of students holding "F31" NIH grants, fellowships that support predoctoral graduate students. Of the 50 students who currently hold such grants, all programs in the Laney Graduate School's Graduate Division of Biological and Biomedical Science (GDBBS) are represented, including MD/PhD students as well as nursing, public health, and psychology doctoral students.
The ranking highlights years of nurturing a culture here that seeks to educate students in writing, presenting, and otherwise communicating effectively about their research.
Biochemist Anita Corbett, who directs writing courses for several graduate programs, sums up the reasons behind the rankings: "We have excellent trainees and faculty sponsors, we have lots of support from GDBBS and the graduate school, and we require formal training in scientific writing for second-year graduate students."
The purpose of the "grants course," which goes by different names in different GDBBS programs, is two-fold: to prepare students for their qualifying exams and to introduce them to the precise, rigorous thinking and writing needed to produce a competitive grant application.
"Most students say it's one of the best things they've had to do here, and the hardest," says Keith Wilkinson, GDBBS director.
Biochemist Rick Kahn, together with Ken Bernstein (now at Cedars-Sinai in Los Angeles), first developed a required course called "Hypothesis Design and Scientific Writing" for the biochemistry, cell and developmental biology program in the late 1990s. Kahn went on to implement a similar course for the neuroscience program, and now all GDBBS programs offer something similar.
"We really consider it a writing course," says Yerkes neuroscientist Lisa Parr, who has been teaching the neuroscience graduate program's class for several years. "The students learn to put together a research proposal in the NIH format and how to support it by designing the best experiments. I try to emphasize to the students how to think about the grant application from the reviewer's standpoint."
Occasionally, says Wilkinson, students push back against having to learn to write a grant application when their postdoctoral plans focus on industry.
"I remind them, 'The game is the same, no matter where you end up working,'" he says. "Someone else has the money, and you have to convince them to give it to you. It's valuable to learn how to ask for support and justify what you want to do."—Quinn Eastman
Holding each other accountable
|Members of WLA Team "Oath Takers" with WLA Dean Gary Teal (second from right): Viraj Master, Elizabeth Larkins, Justin Remais, Christopher Dente, and Raymond Young
When a group from the Woodruff Leadership Academy's class of 2014 presented their class project, "Evaluating the Efficacy of the Emory Healthcare Pledge," to Woodruff Health Sciences Center leadership last year, WHSC Board Chair Doug Ivester found their conclusions compelling. He invited them to present an abbreviated version before the entire WHSC Board at its meeting last November. The result: board members recently signed a resolution (framed in photo above, to be displayed in WHSCAB) endorsing the pledge, adopting it as a guide to their own conduct, and advocating its adoption and promulgation throughout the entire health sciences center.
Some background: The EHC Pledge was inaugurated in Emory Healthcare in 2011 as a defining influence on standards of behavior and communication throughout the organization, starting at the top. The pledge is short and simple, articulating a basic, commonsense, do-unto-others philosophy, but it is also highly powerful—and very challenging—to live by day to day. It gave implicit permission for employees at any level to speak up when they perceived an impending error in a patient procedure or to summon a medical emergency team (code MET) when they thought a patient was in distress. And it was seen as vital to creating a "fair and just" culture in which patient safety and quality of care reign supreme in everyone's minds.
In carrying out their project, members of the WLA "Oath Takers" team, which included two surgeons, a critical care nursing director, a public health faculty member, and a physician faculty member in psychiatry, first explored best practices of other organizations, both health care and non-health care, that had implemented successful culture-changing codes of conduct. They also surveyed employees to benchmark how well Emory's pledge had permeated the culture so far and the effect it was perceived as having on behavior. Although the vast majority of EHC employees (90%) had at least heard of the pledge, the degree of engagement was variable, and the WLA group, not surprisingly, found opportunities for improvement. In their executive summary, they recommended more training and resources to ensure the pledge's full potential and benefits to the culture.
No one could agree more that the pledge needs wider and deeper dissemination than pledge champion Hal Jones, who directs culture in the medical school and was founding director of care transformation in Emory Healthcare (an office now led by Michelle Gray). "Taking the pledge is just the first step and the easy part," he says. "The more challenging part is actually holding each other accountable, in a caring and supportive way, when we've perceived others interacting with us or team members in a manner inconsistent with our pledge." Jones conducts training on how to have constructive "cup-of-coffee" conversations to learn from these situations: I'd like to talk to you about the interaction we had yesterday…
According to Jones, efforts to promulgate the pledge throughout the WHSC are already under way. Emory CEPAR administrator Sam Shartar leads the WHSC's Diversity Committee, which is developing a plan for implementing the pledge among WHSC leadership and staff.
"We are defining benefits of adopting the pledge in non-clinical settings to ensure ethical conduct of research, for example, optimize business efficiencies, and improve the culture of teamwork, service to others, safety, job satisfaction, transparency, and ability to resolve conflicts successfully," he says. "We are developing university-oriented vignettes, identifying trained resources to assist employees, and creating a culture that allows for collegial discussion of concerns."
Please note: The EVPHA office has produced laminated, pocket-size copies of the pledge, which can be obtained from William Payne.
Related: Read about how pledge culture has influenced initiatives to teach compassion in the medical school and a personal story about patient safety from WLA group member and urologic surgeon Viraj Master.
Helping adults with autism practice basic life skills
|Participants practice skills related to self-care needs, including cooking, cleaning, and doing laundry. They also hang out for social time together and with others.
The Emory Autism Center is making use of the Emory campus for an initiative to help adults with autism spectrum disorder learn and practice important life skills.
The pilot program, called myLIFE, provides opportunities for young adults with autism (18 and older) to address issues that are important for independent living, including interaction with other people, communicating their needs, participating in community events, engaging in health-related activities, and getting around on public transportation.
"Studies show that people with autism spectrum disorder learn more about life when interacting with people their own age who do not have the same challenges," explains Toni Thomas, program manager for adult services at the Emory Autism Center. "That’s one of the reasons we decided to make use of the Emory environment and availability of educated volunteers to help each myLIFE group member learn the skills they need to participate in age-appropriate activities with their peers."
Program participants are being exposed to a variety of responsibilities:
- An apartment on the Emory campus provides a place where they can practice skills related to self-care needs, such as cooking, cleaning, and doing laundry. It also provides a comfortable place where the group can hang out for social time together and with others.
- Volunteer mentors take the participants to various functions on campus, ride with them on campus shuttles, and dine with them.
- Training in healthy living skills is provided by a volunteer nutritionist and students from the nursing and medical schools, and participants are required to join one of Emory's campus athletic centers, which have provided discounted passes.
- Activities such as woodworking and gardening are part of the program to introduce participants to new hobbies or potential job skills.
"Our goal is to provide these young adults with exposure to every life experience possible," says Thomas.
This program was funded in part by a grant from the Autism Foundation of Georgia, with additional support from the Georgia Department of Behavioral Health and Developmental Disabilities.
Watch a video on this program.