Improving High Risk Care Management Education in the Outpatient Setting

TL;DR

The ALIGN program trains medical trainees to manage high-risk older patients through an intensive outpatient curriculum and team-based learning.

Contribution

The study introduces and evaluates an innovative outpatient curriculum for training trainees in high-risk geriatric care management.

Findings

Fellows found shadowing the team and managing patients independently most useful.

ALIGN increased trainees' confidence in identifying and managing high-risk older patients.

Most fellows found 1:1 educational sessions with attendings and care coordinators beneficial.

Abstract

The Aging, Life Innovations, Goals & Needs(ALIGN) Program is an innovative intensive ambulatory model of care that manages older “high risk” patients at risk for acute health decline with a thoughtful curriculum designed to highlight approaches to geriatric medical and psychosocial care. ALIGN curriculum (AC) objectives include learning skills in identifying high risk patients and developing a comprehensive geriatric care plan using the 5Ms of Geriatrics framework, plus “Maintaining Care.” Fellows were assigned a small patient panel and participated in team huddles. At rotation end, fellows provided a written sign-out of patients. Following the 2-week AC, fellows completed a post-rotation survey. Six fellows completed the survey between June 2021 and June 2022, rating usefulness (Scale 0-5) of online education, team huddles, shadowing team and confidence in managing high risk patients. Results showed fellows appreciated active 1:1 time with attendings. Subsequently, 13 post-rotation surveys were collected from June 2022-January 2024. Shadowing the team was rated most useful (53.8%) as was seeing patients independently (69.2%). Fellows rated their confidence (scale 0-5) in screening for high-risk older patients as high (average 4.3). Moreover, 61.5 % fellows found 1:1 ALIGN attending education useful, as well as 1:1 educational time with the social worker and care coordinator. For many, ALIGN was their first experience in high-risk patient care management. Likelihood to recommend the ALIGN rotation was 6.9 out of 10. In conclusion, AC is beneficial in promoting leadership and innovation for trainees amidst a perpetually changing landscape in geriatric care.