Institute For Change / Research Center
Publications & Presentations
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Moving Evidence-Based Research into Practice
In support of its mission to change health care, Partners’ Institute for Change/Research Center periodically publishes scholarly articles and edits special editions of journals. The published findings of the Institute’s significant research studies disseminate findings to the national community of practitioners to assist in their education, planning, and implementation of evidence-based health interventions and programs in their organizations. Recent publishing activities of the Institute’s professional staff, in partnership with leading researchers, agencies and providers, include:
Publications & Presentations
Enguidanos, S., Jamison, P., Geron, S., Keefe, B. Social Work in Primary Care: An Evidence-Based Intervention Study for Older Adults. Paper presented at the Society for Social Work and Research Annual Conference, San Francisco, CA, January 11-14, 2007.
Jamison, P., Welsh, M., Corser, C., Simmons, J., Enguidanos, S. Results of a Psychosocial Needs Assessment of People Managing Parkinson’s Disease. Poster presented at the American Society on Aging joint conference with the National Council on Aging, Anaheim, CA, March 15-18, 2006.
Jamison, P. Benefits of Participating in an Internship within an Applied Anthropology Program. Paper presented at the South West Anthropology Association Annual Conference, Pasadena, CA April 28-30, 2006.
Gibbs, N., Enguidanos, S. & Hillary, K. Are We Doing What Are Patients Really Want? Lessons Learned From Retrospective Chart Reviews. Workshop conducted at the Kaiser Permanente End of Life and ElderCare Symposium, Anaheim, CA, November 6, 2006.
Enguidanos, S., Josephson, K., Simmons, J., & Geron. Integrating Social Work Into Primary Care Practice. Workshop conducted at the American Society of Aging Annual Meeting, Anaheim, CA, March 2006.
Enguidanos, S. & Gibbs, N. Treating Depression among Older Adults through Care Management: Results from an Evidence-based Intervention. Paper presented at the 58th Annual Scientific Meeting of the Gerontological Society of America, Orlando, FL, November 2005.
Enguidanos, S. & Pynoos, J. Service Needs Among Two Diverse NORC Communities: Findings from a Needs Assessment. Paper presented at the 58th Annual Scientific Meeting of the Gerontological Society of America, Orlando, FL, November 2005.
Enguidanos, S. & Keefe. Integrating Social Work into Primary Care: Results of Current Research. Paper presented at the 58th Annual Scientific Meeting of the Gerontological Society of America, Orlando, FL, November 2005.
Jamison, P. Preliminary Findings of a Needs Assessment of People Managing Parkinson’s Disease. Poster presented at the 58th Annual Scientific Meeting of the Gerontological Society of America, Orlando, FL, November 2005.
Josephson, K. & Enguidanos, S. Reducing Risk in Patient Transitions. Long Term Care Summit conducted for Bonne Bridges Mueller O’Keefe & Nichols, Anaheim, CA, October 6, 2005.
Enguidanos & Davis. Depression: Blending Effective Depression Interventions into Geriatric Care Management Practice. Workshop conducted at the Kaiser Permanente ElderCare Symposium, Anaheim, CA, June 24, 2005.
Enguidanos & Keefe. Social Work into Primary Care Intervention. Paper presented at the American Society of Aging Annual Meeting, Philadelphia, PA, March 2005.
Enguidanos, S. Replication of a Home-Based Palliative Care Program: A Multi-site Study. Paper presented at the American Society of Aging Annual Meeting, San Francisco, CA, March 2004.
Brumley, R & Enguidanos, S, et al.. Replicating a Home-Based Palliative Care Program: A Multi-site Study. Workshop conducted at the American Academy of Hospice and Palliative Medicine Annual Conference, Phoenix, AZ, January 19-23, 2004.
Enguidanos, S., & Jamison, P. One Year Results from an Evaluation of Four Levels of Geriatric Care Management. Paper presented at the 6th Annual Conference on Case Management, Philadelphia, PA., October 26-29, 2003.
Brumley, R., Enguidanos, S., & Jamison, P. Developing a Home-Based Palliative Care Program. Workshop conducted at the 6th Annual Conference on Case Management, Philadelphia, PA., October 26-29, 2003.
Enguidanos, S., & Gibbs, N. Treating Depression through Geriatric Care Management. Paper presented at the 2003 Joint Conference of the National Council on the Aging and American Society of Aging, Chicago, Ill., March 9-12, 2002.
Enguidanos, S., & Gibbs, N. Geriatric Care Management: Detecting and Treating Depression. Paper presented at the American Public Health Association 130th Annual Meeting, Philadelphia, PA, November 9-12, 2002.
Enguidanos, S., Rios-Ellis, B., Dwyer, M., Leon, R., Roman, R., Useche, B., & Ugarte, C. Latina HIV/AIDS Needs Assessment: Moving Towards Culturally Appropriate Prevention. Paper presented at the American Public Health Association 130th Annual Meeting, Philadelphia, PA, November 9-12, 2002.
Brumley, R., & Enguidanos, S. Innovation in End-of-Life Care: Shifting the Paradigm from Hospital to Home. Paper presented at the American Public Health Association 130th Annual Meeting, Philadelphia, PA, November 9-12, 2002.
Ell, K., Unutzer, J., Enguidanos, S., & Aranda, M. Geriatric Care Management: Detecting and Treating Depression. Paper presented at the American Public Health Association 130th Annual Meeting, Philadelphia, PA, November 9-12, 2002.
Enguidanos, S., & Gibbs, N. Community Partners: Strengthening Partnerships between AAAs & MCOs to Improve the Health of Frail Elders. Paper presented at the American Society of Aging Annual Meeting, New Orleans, LA, March 2001.
Enguidanos, S., & Simmons, J. Geriatric Care Management: Outcome of a Managed Care Model & Future Implications. Presented at the 53rd Annual Scientific Meeting of the Gerontological Society of America, Washington, DC, November 2000.
Ethnic Variation in Site of Death of Older Adults Dually Eligible for Medicaid and Medicare. J Am Geriatr Soc. 2005 Aug;53(8):1411-6. Written by Enguidanos, Yip, & Wilber with funding in part through a contract with the California Department of Health Services and published in the Journal of the American Geriatric Society, August, 2005, this retrospective study demonstrates that, although minorities are more likely to die at home, they are less likely to receive hospice care, and recommends that physicians ensure that minority patients understand all end-of-life care options.
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Improving Medication Management in Home Care: Issues and Solutions This special edition, edited by Dennee Frey, Pharm D., is based on Partners’ widely recognized medications management projects. It provides a review of the research literature on this subject and points out gaps in knowledge. A new report on Partners’ studies is due for publication in Spring, 2006.
Evidenced Based Interventions for Community Dwelling Older Adults Edited by Susan Enguidanos, Ph.D., this special double issue of Home Health Quarterly publication in Spring, 2006, presents articles on evidence-based models and best practices for older adults with an emphasis on falls prevention, case management, depression treatment, palliative care, medication management, and physical activity.
Risk of medication errors at hospital discharge and barriers to problem resolution. Enguidanos SM, Brumley RD.
Medication errors are common among older adults, particularly among those who are at heightened risk due to transfer between care settings. Determining accurate medications for hospitalized patients is a complicated process. This paper presents findings from a small pilot study conducted to identify medication documentation problems at the point of hospital discharge among older adults and the problems encountered in developing new technological systems to address these problems. A prospective study was conducted within a managed care medical center that included patient and physician surveys and chart reviews. A review of 104 medical records revealed several problems in the documentation of patient medication including legibility, use of medical abbreviations and incomplete and missing entries. While patients overall were satisfied with medications communication efforts at discharge, physicians surveyed reported that these methods were inadequate in transmitting medication lists to primary care physicians, patients and other care providers. Patients reported taking more drugs than what were listed in the medical record. These findings led to the development, testing, and implementation of an electronic medication sheet. Despite the success in developing this new system, few physicians engaged in its use, with most preferring to continue with their standard discharge practices of written communication.
Implications of translating research into practice: a medication management intervention. Alkema GE, Frey D. Home Health Care Serv Q. 2006;25(1-2):33-54.
Through programs such as the Administration on Aging's Evidence-Based Prevention Initiative, researchers and practitioners are developing translational research studies seeking to implement rigorously tested, evidence-based interventions in new practice settings and evaluate the continuing effectiveness of these interventions. One such translational study is the Community-Based Medications Management Intervention (CBM Intervention), a collaborative effort to implement a medication management screening and intervention protocol in community-based waiver care management programs. The overall goals of the CBM Intervention are to implement an evidence-based medication management intervention in a California Medicaid waiver care management program, and to evaluate the effect of client-, intervention-, and organizational-level characteristics on resolving identified medication problems. This article presents the need for improved medication management in a frail, community-dwelling, older adult population and describes the CBM Intervention as an example of translating an evidence-based practice beyond its original efficacy trial in a home healthcare program into a care management program. It discusses critical factors involved in translating research into practice using a translational research framework, Promoting Action on Research Implementation in Health Services (PARIHS). Our experience suggests that although implementing research into practice can positively impact client care, professional skill enhancement and organizational effectiveness, this is very challenging work requiring signification facilitation for successful outcomes.
Shifting the paradigm in geriatric care management: moving from the medical model to patient-centered care. Enguidanos SM, Davis C, Katz L. Soc Work Health Care. 2005;41(1):1-16.
Studies of Geriatric Care Management Programs have had mixed results at best. Little evidence exists to attest to the effectiveness of these programs in improving patient outcomes and decreasing avoidable acute care service use. In response to these data, Kaiser Permanente's Geriatric Care Management program initiated a randomized trial to test an integrated, multifaceted depression treatment model within the care management framework and it's ability to detect and treat moderately and severely depressed older adults. This paper presents case studies of the geriatric care managers' practice changes associated with this intervention as well as case studies of two depressed clients, their experiences and outcomes associated with this study. Implications of this model are discussed.
Physicians as medical center "extenders" in end-of-life care: physician home visits as the lynch pin in creating an end-of-life care system. Cherin DA, Enguidanos SM, Jamison P. Home Health Care Serv Q. 2004;23(2):41-53.
The article reviews a successful community-based end-of-life home care program. Specifically, physician visits were compared in the models of care studied, and it was concluded that the community-based model patients benefited significantly over the standard model of care patients due to the use of physicians.
Improving medication use in newly admitted home healthcare patients: a randomized controlled trial.Meredith S, Feldman P, Frey D, Giammarco L, Hall K, Arnold K, Brown NJ, Ray WA. Department of Preventive Medicine, Division of Pharmacoepidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA.
OBJECTIVES: To test the efficacy of a medication use improvement program developed specifically for home health agencies. The program addressed four medication problems identified by an expert panel: unnecessary therapeutic duplication, cardiovascular medication problems, use of psychotropic drugs in patients with possible adverse psychomotor or adrenergic effects, and use of nonsteroidal antiinflammatory drugs (NSAIDs) in patients at high risk of peptic ulcer complications. It used a structured collaboration between a specially trained clinical pharmacist and the patients' home-care nurses to improve medication use. DESIGN: Parallel-group, randomized controlled trial. SETTING: Two of the largest home health agencies in the United States. PARTICIPANTS: Study subjects were consenting Medicare patients aged 65 and older admitted to participating agency offices from October 1996 through September 1998, with a projected home healthcare duration of at least 4 weeks and at least one study medication problem. INTERVENTION: Qualifying patients were randomized to usual care or usual care with the medication improvement program. MEASUREMENTS: Medication use was measured during an in-home interview, with container inspection at baseline and at follow-up (between 6 and 12 weeks) by interviewers unaware of treatment assignment. The trial endpoint was the proportion of patients with medication use improvement according to predefined criteria at follow-up. RESULTS: There were 259 randomized patients with completed follow-up interviews: 130 in the intervention group and 129 with usual care. Medication use improved for 50% of intervention patients and 38% of control patients, an attributable improvement of 12 patients per 100 (95% confidence interval (CI) = 0.0-24.0, P =.051). The intervention effect was greatest for therapeutic duplication, with improvement for 71% of intervention and 24% of control patients, an attributable improvement of 47 patients per 100 (95% CI = 20-74, P =.003). Use of cardiovascular medications also improved more frequently in intervention patients: 55% vs 18%, attributable improvement 37 patients per 100 (95% CI = 9-66, P =.017). There were no significant improvements for the psychotropic medication or NSAID problems. There was no evidence of adverse intervention effects: new medication problems, more agency nurse visits, or increased duration of home health care. CONCLUSIONS: A program congruent with existing personnel and practices of home health agencies improved medication use in a vulnerable population and was particularly effective in reducing therapeutic duplication.
Effectiveness of a home-based palliative care program for end-of-life. Brumley RD, Enguidanos S, Cherin DA. J Palliat Med. 2003 Oct;6(5):715-24.
CONTEXT: Despite the widespread recognition of the need for new models of care to better serve patients at the end-of-life, little evidence exists documenting the effectiveness of these models. OBJECTIVE: To evaluate the effectiveness of a palliative program for end-of-life care. DESIGN: A comparison group study was conducted between March 1999 and August 2000 comparing subjects enrolled in a palliative care intervention to those receiving usual care. SETTING: Home Health Department at Kaiser Permanente, TriCentral Service Area. SUBJECTS: During the course of the 2-year study, 558 subjects were enrolled. A subgroup of 300 patients who had died during the course of the study was selected for analysis; 161 were enrolled in the Palliative Care Program and 139 in the comparison group. INTERVENTION: The Kaiser Permanente Palliative Care Project is a multidisciplinary care management approach for home-based end of life care and treatment. The program is designed to facilitate the transition from acute to palliative care during the last 12 months of life with the goal of improving quality of life through the provision of symptom control and pain relief, emotional and spiritual support, and patient education. MAIN OUTCOME MEASURES: Medical service use and satisfaction with services. RESULTS: Palliative care patients had increased satisfaction with services at 60 days after enrollment and significantly fewer emergency department visits, hospital days, skilled nursing facility days, and physician visits than those in the comparison group. Those enrolled in palliative care averaged a 45% decrease in costs as compared to usual care patients. CONCLUSION: Through integrating palliative care into curative care practices earlier in the disease trajectory, chronically ill patients nearing the end of life report improved satisfaction with care and demonstrate less acute care use resulting in lower costs of care. In addition, patients enrolled in the palliative care program were more likely to die at home than comparison group patients.
Kaiser Permanente community partners project: improving geriatric care management practices. Enguidanos SM, Gibbs NE, Simmons WJ, Savoni KJ, Jamison PM, Hackstaff L, Griffin AM, Cherin DA. J Am Geriatr Soc. 2003 May;51(5):710-4.
This article describes a geriatric care management project that is testing whether geriatric care management plus a brief purchase of service (POS) intervention will lower medical costs, improve satisfaction with care, increase care plan adherence, and improve perceived quality of life. Kaiser Permanente members aged 65 and older who were eligible for geriatric care management and consented to participate in the study were randomized to one of four study groups: information and referral via mail, telephone care management, geria%20
Care management, or geriatric care management with POS capability.
The POS intervention provides up to $2,000 of designated, paid services including in-home supportive services, transportation, respite, or medical equipment within the first 6 months of care management enrollment. Approximately 1,400 senior members were referred to the geriatric care management program, and 451 were randomly assigned to one of the four study groups. Those enrolled in the geriatric care management program were significantly more likely to be ethnic minorities and have lower income than the general Kaiser Permanente senior enrollment. Barriers encountered in implementing the POS intervention included establishing contractual agreements between Kaiser Permanente and private and community agencies, locating adequate and sufficient community agencies to provided needed services, monitoring service contracts, and delaying use of the POS benefit.
For more information, contact: Dr. Susan Enguidanos, Research Director Partners’ Institute for Change/Research Center senguidanos@picf.org
Presentations
Enguidanos, S., Jamison, P., Geron, S., Keefe, B. Social Work in Primary Care: An Evidence-Based Intervention Study for Older Adults. Paper presented at the Society for Social Work and Research Annual Conference, San Francisco, CA, January 11-14, 2007.
Jamison, P., Welsh, M., Corser, C., Simmons, J., Enguidanos, S. Results of a Psychosocial Needs Assessment of People Managing Parkinson’s Disease. Poster presented at the American Society on Aging joint conference with the National Council on Aging, Anaheim, CA, March 15-18, 2006.
Jamison, P. Benefits of Participating in an Internship within an Applied Anthropology Program. Paper presented at the South West Anthropology Association Annual Conference, Pasadena, CA April 28-30, 2006.
Gibbs, Enguidanos & Hillary. Are We Doing What Are Patients Really Want? Lessons Learned From Retrospective Chart Reviews. Workshop conducted at the Kaiser Permanente End of Life and ElderCare Symposium, Anaheim, CA, November 6, 2006.
Enguidanos, Josephson, Simmons, & Geron. Integrating Social Work Into Primary Care Practice. Workshop conducted at the American Society of Aging Annual Meeting, Anaheim, CA, March 2006.
Enguidanos & Gibbs. Treating Depression among Older Adults through Care Management: Results from an Evidence-based Intervention. Paper presented at the 58th Annual Scientific Meeting of the Gerontological Society of America, Orlando, FL, November 2005.
Enguidanos & Pynoos. Service Needs Among Two Diverse NORC Communities: Findings from a Needs Assessment. Paper presented at the 58th Annual Scientific Meeting of the Gerontological Society of America, Orlando, FL, November 2005.
Enguidanos & Keefe. Integrating Social Work into Primary Care: Results of Current Research. Paper presented at the 58th Annual Scientific Meeting of the Gerontological Society of America, Orlando, FL, November 2005.
Jamison, P. Preliminary Findings of a Needs Assessment of People Managing Parkinson’s Disease. Poster presented at the 58th Annual Scientific Meeting of the Gerontological Society of America, Orlando, FL, November 2005.
Josephson, K. & Enguidanos, S. Reducing Risk in Patient Transitions. Long Term Care Summit conducted for Bonne Bridges Mueller O’Keefe & Nichols, Anaheim, CA, October 6, 2005.
Enguidanos & Davis. Depression: Blending Effective Depression Interventions into Geriatric Care Management Practice. Workshop conducted at the Kaiser Permanente ElderCare Symposium, Anaheim, CA, June 24, 2005.
Enguidanos & Keefe. Social Work into Primary Care Intervention. Paper presented at the American Society of Aging Annual Meeting, Philadelphia, PA, March 2005.
Enguidanos, S. Replication of a Home-Based Palliative Care Program: A Multi-site Study. Paper presented at the American Society of Aging Annual Meeting, San Francisco, CA, March 2004.
Brumley, R & Enguidanos, S, et al.. Replicating a Home-Based Palliative Care Program: A Multi-site Study. Workshop conducted at the American Academy of Hospice and Palliative Medicine Annual Conference, Phoenix, AZ, January 19-23, 2004.
Enguidanos, S., & Jamison, P. One Year Results from an Evaluation of Four Levels of Geriatric Care Management. Paper presented at the 6th Annual Conference on Case Management, Philadelphia, PA., October 26-29, 2003.
Brumley, R., Enguidanos, S., & Jamison, P. Developing a Home-Based Palliative Care Program. Workshop conducted at the 6th Annual Conference on Case Management, Philadelphia, PA., October 26-29, 2003.
Enguidanos, S., & Gibbs, N. Treating Depression through Geriatric Care Management. Paper presented at the 2003 Joint Conference of the National Council on the Aging and American Society of Aging, Chicago, Ill., March 9-12, 2002.
Enguidanos, S., & Gibbs, N. Geriatric Care Management: Detecting and Treating Depression. Paper presented at the American Public Health Association 130th Annual Meeting, Philadelphia, PA, November 9-12, 2002.
Enguidanos, S., Rios-Ellis, B., Dwyer, M., Leon, R., Roman, R., Useche, B., & Ugarte, C. Latina HIV/AIDS Needs Assessment: Moving Towards Culturally Appropriate Prevention. Paper presented at the American Public Health Association 130th Annual Meeting, Philadelphia, PA, November 9-12, 2002.
Brumley, R., & Enguidanos, S. Innovation in End-of-Life Care: Shifting the Paradigm from Hospital to Home. Paper presented at the American Public Health Association 130th Annual Meeting, Philadelphia, PA, November 9-12, 2002.
Ell, K., Unutzer, J., Enguidanos, S., & Aranda, M. Geriatric Care Management: Detecting and Treating Depression. Paper presented at the American Public Health Association 130th Annual Meeting, Philadelphia, PA, November 9-12, 2002.
Enguidanos, S., & Gibbs, N. Community Partners: Strengthening Partnerships between AAAs & MCOs to Improve the Health of Frail Elders. Paper presented at the American Society of Aging Annual Meeting, New Orleans, LA, March 2001.
Enguidanos, S., & Simmons, J. Geriatric Care Management: Outcome of a Managed Care Model & Future Implications. Presented at the 53rd Annual Scientific Meeting of the Gerontological Society of America, Washington, DC, November 2000.
