Tailored risk for older adults: SILVER-AMI

dodson%20headshotWe recently published a paper on predicting 30-day readmission for older adults with acute myocardial infarction (AMI) in Circulation: Cardiovascular Quality and Outcomes. Our purpose was to evaluate whether aging-related functional impairments in mobility, cognition, and sensory domains would help to predict whether AMI patients would be readmitted to the hospital within 30 days of discharge, which has been subject of increasing focus by payors and health systems over the past decade. We analyzed data from the SILVER-AMI study, which exclusively enrolled participants aged ≥75 years, and included a detailed assessment of functional impairments.

What we found:

  • Among 3006 study participants with AMI (mean age 81.5 years), 547 (18.2%) were readmitted within 30 days.
  • Readmitted participants were older, with more comorbidities, and had a higher prevalence of functional impairments including disability in activities of daily living (17.0% vs. 13.0%), impaired functional mobility (72.5% vs. 53.6%) and weak grip strength (64.4% versus 59.2%).
  • After statistical modeling, our final risk model included 8 variables: functional mobility, ejection fraction, chronic obstructive pulmonary disease, arrhythmia, acute kidney injury, first diastolic blood pressure, P2Y12 inhibitor use, and general health status. While functional mobility was the only aging-related functional impairment retained in this model, it was also the strongest individual predictor.

Our risk model was well calibrated across categories of risk but had only modest discrimination – meaning there were other factors contributing to readmission risk (for example, related to the care environment or health system), that were not captured in SILVER-AMI.

Our hope is that our score can be used in a practical setting – for example, identifying patients for more intensive post-discharge care. Accordingly, our calculator is freely available at silverscore.org, or in the App Store here.

 

By: John Dodson, MD, MPH

 

CoMPAdRE: A Connecting Point for Aging Researchers

Ruth Masterson CreberWhat is the CoMPAdRE program?
The CoMPAdRE program is an interprofessional, early career mentorship program for faculty who are interested in patient-centered aging research. The acronym CoMPAdRE stands for Columbia University Mentor Peer Aging Research. Compadre also means “friend or companion,” representing the purpose of this program—to build a network of peer relationships that can be sustained over the course of a career.

Many traditional mentoring programs are structured as dyadic relationships between a senior mentor and junior mentee. However, this traditional dyadic model can put undue pressure on both the mentor and mentee.  Moreover, mentees may have trouble identifying senior mentors who are available and willing to invest the time needed to develop a productive dyadic relationship. This issue is particularly problematic for women and racial and ethnic minorities who traditionally have had less access to professional networks (additional information here) with potential senior mentors. There is a large body of research demonstrating the benefits of mentorship, such as access to career development opportunities; therefore, individuals who are excluded from mentorship opportunities are often disadvantaged with regard to career development. CoMPAdRE seeks to address shortcomings of traditional mentoring programs by offering a new model: a hybrid of a dyadic and peer mentorship model, known as facilitated peer mentorship. The program is led by a senior mentor, Mathew Maurer MD, but the focus is on building a strong, interprofessional peer network.

Why is this program interprofessional?
Over the past decade, the care of older adults has become much more clinically complex and fragmented. As patients live longer with multiple comorbid conditions, they are receiving care from a number of specialized providers, creating greater possibilities for fragmentation in care. Collaborative mentorship teams facilitate sharing of ideas and learning opportunities across disciplines. For example, when caring for older adults with heart failure, programs such as the Heart Failure with Preserved Ejection Fraction Program at Weill Cornell Medicine include physicians, nurses, and social workers. Both holistic patient care and thought leadership require an interprofessional team that bring together specific domain expertise. By bringing together a diverse cohort of health professionals from across the country, CoMPAdRE has facilitated a unique learning experience for sharing ideas, developing skills, and building relationships.

How does CoMPAdRE impact patients?
The value of mentorship goes back to the underlying importance of reducing clinician burnout and supporting sustainability. When healthcare providers feel connected through a common mission, they have more capacity to fully engage with the needs of their patients, and conduct high-impact research focused on improving patient outcomes. Clinicians and researchers thrive most when they feel their work is valued.

What will you take away from this program?
Mentorship and giving back to the community takes place at every career stage. CoMPAdRE has hosted many global leaders in aging including Drs. Luigi Ferrucci, Linda Fried, Stephanie Studenski, Terry Fulmer, Mary Tinetti, and Mark Supiano, among others. Each speaker not only shared their career highlights, but the accompanying personal stories that paralleled the highs and lows of their careers. As a group, we learned how to manage time, stay focused, and most of all, value and cultivate relationships. A major theme of discussion throughout the program was that, over the course of clinical training, skills in management, leadership, and administration are not taught, and yet are expected as part of the job. One of the benefits of this program is that it provides the mentees with a structured opportunity to learn more about these skills with direct application into our clinical practices and programs of research.

Despite being a program for “early career” faculty, we were all encouraged to not only seek out mentorship and support, but to also serve as mentor to others. A critical takeaway point from this program was the necessity of mentoring at all career levels; it is never too early or too late to support others through mentorship.

How can we find out more about the program?
If you are interested in finding out more information about this CoMPAdRE program, you can read more details about this program in the Journal of the American Geriatrics Society.

 

By: Ruth Masterson Creber, PhD, MSc, RN

Ruth Masterson Creber is an Assistant Professor of the Department of Healthcare Policy and Research at Weill Cornell Medicine.