Vol XXVIII, Oct `06

Daniel Bluestein, MD, MS, CMD has received QI awards in 2004 and 2006. "We have completed the study we submitted in 2004 and are preparing an article for JAMDA. In that study, we learned that a point-of-care International Normalized Ratio (INR) device is not appropriate for all patients. There are lots of variables that must be considered," he observed.

This year's award-winning study addressed "Measuring the Outcomes of Dementia Therapy: What Matters to Caregivers." Bluestein explained, "We wanted to look at how caregivers weigh the benefits of drugs against the barriers—such as costs or potential side effects. We want to understand what motivates medication choice decisions because they can be important in helping family members determine how to spend their money."

Bluestein, an active Research Network member, is committed to pursuing studies that solve care-related problems or questions that practitioners have. "Both of my studies grew out of questions in practice that I had or that were brought to my attention," he observed. For example, the dementia study grew out of an in-service he presented last June. "The nurses mentioned that they don't know if dementia drugs do anything. So I started to wonder what is important to caregivers and what functional improvements they are most concerned about," he offered. Both studies, he stressed, are a way of team-building.

This dementia study ultimately will involve several facilities. However, Bluestein is starting with two facilities where he is the medical director. "The next step is to get people to fill out a fairly extensive survey. We will be working to help them understand why it is valuable and important for them to be involved." (Motivating nurses and other staff to participate in studies and understanding how they feel about these efforts will be the topic of a Caring for the Ages article later this year.)

According to Bluestein, he hopes that the results will help physicians make optimal prescribing decisions that include an understanding of family and caregiver goals for the patient. Additionally, he believes that a staff and family education component will be useful. When caregivers and families understand these drugs, he explained, they can help monitor for outcomes and side effects.

"My interest in the AMDA Foundation QI awards has been fairly longstanding," said Julie Gammack, MD, a third-time participant in the program and second-time award recipient. "I am interested in long term care education and feel that the nursing home is a site that often is neglected in medical education and research." Of her first award, she said, "My interest in sleep started with a review article I co-authored on the subject. I had a student working with me who was interested in sleep disorders in the elderly; and we developed a project for her to study sleep in the nursing home. The pilot work was funded by the American Federation for Aging Research, and AMDA funded the follow-up work."

Gammack's second and most recent award-winning project addresses oral care in the elderly. "We wanted to explore how oral care is delivered in the nursing home and to develop interventions to improve care. Our project is just starting, and we will be doing our first in-service education programs at two nursing homes next week," Gammack explained. If the results of the pilot are supportive, she added, "We will pursue the research on a larger scale."

The American Medical Directors Association Foundation (AMDA-F) continues to partner with Pfizer on the Quality Improvement Awards Program — now in its sixth year. The Awards, $10,000 — $15,000 each, will support initiatives that focus on facility staff education, quality improvement programs, research on interventions and treatment, and health literacy to directly enhance the quality of care provided to patients in long term care settings. For further information, please log on to www.amda.com/foundation/grants.cfm. The deadline for applications is November 13, 2006.