Transcript Charles B. Wang Community Health Center Profile of Chinese American Elders Enrolled in a Geriatric Program at an NYC Community Health Center 10/1/2009 –

Charles B. Wang Community Health Center
Profile of Chinese American Elders
Enrolled in a Geriatric Program at an
NYC Community Health Center
10/1/2009 – 9/30/2011
APHA Annual Meeting
November 1, 2011
Presenter Disclosures
Ady Oster
The following personal financial relationships with
commercial interests relevant to this presentation
existed during the past 12 months:
No relationships to disclose
Summary
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Chinese-Americans are fastest-growing elderly
segment in NYC
Face multiple barriers – language, poverty,
education, culture
We report on our experience in caring for 230
vulnerable elders in a primary care-based
geriatric practice
Center Background
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Charles B. Wang Community Health Center
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FQHC founded in 1971
4 locations in Manhattan and Queens
40,000 patients making >200,000 visits in 2010
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90% prefer language other than English
Manhattan’s Chinatown
Pell Street, 2009
Manhattan’s Chinatown
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Population 2006: 84,800
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66% Asian
59% foreign-born
70% of Asians < high school education
71% elders: limited English proficiency
31%: below poverty line
Proportion of Elders in Chinatown growing:
30% increase over 10 years
Asian American Federation of New York, 2004
Program Background
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Needs assessment (2006):
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Chinese elders report difficulty navigating health and social
service system
Increased need for health care, social services, care
coordination and outreach
Medical Home for Chinese American Elders:
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geriatric practice serving vulnerable elderly modeled on
Patient-Centered Medical Home
Two-year period
Launched: October 1, 2009
Program Background
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Enhanced services:
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Service goal
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Screen for vulnerability
Comprehensive geriatric assessment
Psychosocial assessment
Individual care plans
Medication management
Screen 1,000 seniors for vulnerabilities
Enroll 200 for enhanced care
Funding
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Program Cost: total ~ 500K
Fan Fox and Leslie R. Samuels Foundation contribution: 250K
Program Outline:
Initial Geriatric Screen
n =1,572
Negative
n = 1,161
Positive
n = 411
VES 13
Negative
n = 181
Positive
n = 230
Comprehensive Geriatric Evaluation
n = 214
Declined to participate
n = 16
Demographics
Gender
Ethnicity
n=230
n=230
Caucasian
1%
Male
42%
Female
58%
Chinese
98%
1%
Other
Demographics
Language
Birth Country
n=230
n=230
China
Cantonese
83%
94%
Mandarin
USA
14%
1%
1%
English
2%
1%
Other
Taiwan
4%
Other
Demographics
Medicare only, 3%
Insurance*
Managed Medicaid,
3%
Medicaid only, 4%
n=230
Private, 5%
Managed Medicare,
6%
Dual (Medicare
& Medicaid), 79%
*Insurance status for primary or secondary insurance
Assessments
Mini-Cog:
Timed Get up and Go:
Unknown
8%
Negative
53%
Normal
38%
Positive
21%
Abnormal
54%
Unknown
26%
N= 214
Assessments
Scale
N
ADL
203
10.4
(2.1)
201
9.6
(3.8)
177
1.63
(3.0)
49
55.0
(5.3)
49
42.3 (9.3)
(Activities of Daily Living; Range from 0-12)
IADL
(Instrumental Activities of Daily Living; Range 0-16)
K6
(Psychological Distress Assessment; Range 0-20)
SF-8 Mental Score
(Quality of Life; Range 30-70; US mean = 50)
SF-8 Physical Score
(Quality of Life; Range 30-70; US mean =50)
Mean (SD)
Services Utilized:
Provider Visits
Total = 2,633
Mean = 11.4
SD = 5.6
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Services Utilized:
Social Work Visits
Total = 1, 614
Mean = 7.0
SD = 9.1
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Services Utilized:
Frequency of Mental Health Visits
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Services Utilized:
Frequency of ED Visits or Hospitalizations
Elders with hospital visits = 7
Elders with ED visits = 22
Overall:
Total Visits = 111
Mean = 0.5
Limited to those with
ED/Hospital visit:
N = 29
Mean = 3.8
SD = 1.7
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SD = 3.1
Reasons for Hospitalization or ED Visits
(n = 57)
100%
100%
95%
98%
89%
Incidence
90%
82%
Cummulative Incidence
80%
73%
75%
70%
61%
60%
50%
50%
41%
40%
30%
25%
21%
20%
20%
20%
13%
9%
7%
5%
10%
4%
2%
0%
0%
Trauma
CV
ID
Neuro
GI
ONC
Pulm
GU
Heme
Conclusions
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Chinese Elders enrolled in a primary care
geriatric program
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Multiple visits with providers and social workers
High rates of dementia (mild), mobility difficulty,
diminished capacity performing IADL’s
Low rates reported depression/other psychiatric illnesses
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Low utilization of mental health services
Relatively low overall utilization of ED/Hospitals
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Small group of high utilizers
Barriers:
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Lack of language-proficient social work
support
Need for language-proficient Home Health
Aids
Transportation barriers
Cultural barriers accessing mental health?
Possible Future Programs:
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Patient navigation
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Travel companions
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Social work funding
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For FQHC
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For patients receiving care from private MD’s
Thank You
We are grateful for the generous support from
the Fan Fox & Leslie R. Samuels Foundation
Team Members
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Clinical Director: Ady Oster, MD, MBA
Program Advisor: Susan Seto-Yee, RN, MPA
Program Manager: Jaclyn Tsang
Physician Champion: Ginger Wey, MD
Social Worker: Amanda Wong, LMSW
Social Work Assistant: KC Wong
Registered Nurse: Joyce Ling, RN
Care Manager: Cora Toa
Health Educator: Melissa Ip, RD
Contributing managerial staff: Regina Lee, JD; Manna Chan-Espin,
LCSW; Tracy Wu, RN; Ida Wong; Ina Elbaar; Shao-Chee Sim,
PhD; Perry Pong, MD; Betty Cheng, LCSW
Geriatric Screening Tool
Vulnerable Elders Survey (VES-13)
Geriatric Assessment
Mini-Cog Dementia Screening
KATZ Activities of Daily Living
(ADL) Scale
LAWSON Instrumental Activities of
Daily Living (IADL) Scale
Medication Management Assessment
Psychosocial Assessment (page 1)
Psychosocial Assessment (page 2)
Psychosocial Assessment (page 3)
Emergency Room (ER) History
Hospitalization History