The Acute Care for Elders Tracker at Aurora Health Care

The Problem
Aurora Health Care is a nonprofit, integrated delivery system consisting of 15 hospitals, 155 clinics and 1600 employed physicians throughout Wisconsin. To improve care for their most complex patients in areas where they may not have physicians trained in geriatrics, they installed the Acute Care for Elders (ACE) tracker. Following ACE regulations, this is computerized tool is designed to improve care for hospitalized elderly patients.

The Solution
The ACE tracker provides the multidisciplinary care teams with real-time information on each patient's health risks based on retrospective and aggregate analysis, and allows the teams to customize treatment plans. To facilitate the individualized care plans, the teams use e-Geriatrician, which utilizes teleconferencing to allow geriatricians to consult with staff at hospitals that do not have someone trained in this specific population. The team meets for 30 minutes a day, five days a week to review the ACE tracker report on each patient, develop a plan or make necessary modifications. The team overseeing the inpatient care includes clinical nurse specialists, social workers, pharmacists, physical therapists and occupational therapists. Geriatricians attend the meeting twice a week. If the hospital in question does not have one, a geriatrician from another Aurora facility will participate twice a week via teleconferencing.

Aurora receives no additional funding beyond traditional diagnosis-related group or fee-for-service reimbursement (depending on payer). Additionally, for participating organizations without a geriatrician on staff, Aurora reimburses the physician an additional hourly rate for joining ACE team meetings twice a week via teleconference.

The Result
Initial published data has shown that the percentage of patients receiving urinary catheters decreased from 26.2% to 20.1%, and the share of patients receiving physical therapy consultations has risen from 27% to 39.1%. These large charges can only be described by a result of the regular, multidis¬ciplinary team meetings to improve care plans.

This case study was originally featured in the HPOE guide: 'Caring for Vulnerable Populations,' published January, 2012.

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