Search

Purpose To create a curriculum innovation for early preclinical medical students to explore personal perspectives by listening to and learning from the lived experience of community-living older adults. Method Tell Me Your Story (TMYS) paired first-year medical students (MS1s) with community-dwelling older adult partners (OAPs) residing in the independent living portion of a continuing care retirement community (CCRC) for a half-day educational experience. MS1s conducted 1-hour semi-structured interviews with their OAP and then formed small groups with geriatric faculty members to explore experiences and views that were either reinforced or challenged. The authors evaluated the effectiveness of this exercise using post-activity surveys. A mixed-methods analysis of 7 years of data (2013-2019) was conducted. Results TMYS had 1251 MS1 participants from 2013 to 2019. Students completed 1052 surveys for a response rate of 84%. During the semi-structured interview with OAP, the frequency of issues discussed included relationships (94%), professionalism/art of medicine (91%), healthcare accessibility (83%), death/dying/grieving/loss (72%), nutrition (69%), ethics (64%), and cultural competence (61%). Exactly 97% (n = 1023) responded that the overall organization was "good, very good or excellent." The most prominent themes identified by student responses highlighted person-centered care, patient perspective, life experience/personal stories, and doctor-patient relationship. Fifty-three faculty members completed the post-program survey. Exactly 100% (53/53) rated the quality of this exercise as an educational experience high. Conclusion TMYS was highly valued by students and provided an important experiential learning activity in preclinical medical education. Themes related to person-centered care emerged from the intervention.

Background Cardiovascular risk factor control is challenging, especially in disadvantaged populations. However, few statewide efforts exist to tackle this challenge. Therefore, our objective is to describe the formation of a unique statewide cardiovascular health collaborative so others may learn from this approach. Methodology With funding from the Ohio Department of Medicaid's Ohio Medicaid Technical Assistance and Policy Program, we used a collective impact model to link the seven medical schools in Ohio, primary care clinics across the state, the Ohio Department of Medicaid, and Ohio's Medicaid Managed Care Plans in a statewide health improvement collaborative for expanding primary care capacity to improve cardiovascular health in Ohio. Results Initial dissemination activities for primary care teams included a virtual case-based learning series focused on hypertension and social determinants of health, website resources, a monthly newsletter with clinical tips, webinars, and in-person conferences. The collaborative is aligned with a separately funded hypertension quality improvement project for paired implementation. Conclusions The collective impact model is a useful framework for developing a statewide collaborative focused on the dissemination and implementation of evidence-based best practices for cardiovascular health improvement and disparity reduction. Statewide collaboratives bringing payers, clinicians, and academic partners together have the potential to substantially impact cardiovascular health.

Background Virtual reality has promise as a training method within the affective domain, but investigation is still needed for intention to change behaviors based on social determinants of health. Objective The objective of this study was to describe the self-reported changes in knowledge and/or attitudes and planned behavior changes by healthcare workers for their future care of persons with challenges to their social determinants of health following completion of a first-person virtual reality experience. Design A descriptive qualitative design was used. Settings This study was conducted in clinics and private practice settings in Ohio (United States). Participants This study was conducted with 206 healthcare workers. Methods Participants completed a virtual reality simulation followed by qualitative, open-ended questions about changes to their knowledge, attitudes, and behaviors. Responses were analyzed using a content analysis method. Results Four overarching themes were derived from the qualitative data: (1) Acknowledgement of Social Determinants of Health, (2) An Improved Provider Experience for Patients, (3) Patient as a Person with Complex Needs, and (4) The Learning Experience. Conclusion Findings suggest virtual reality has strong merits for impacting affective domain of learning demonstrated by increased empathy. Virtual reality along with increased empathy also helps improve attitudes and behaviors for the betterment of patients.

OBJECTIVES To develop a competency-based, adaptable home visit curricula and clinical framework for family medicine (FM) residents, and to examine resident attitudes, self-efficacy, and skills following implementation. DESIGN Quantitative analysis of resident survey responses and qualitative thematic analysis of written resident reflections. SETTING Urban FM residency program. PARTICIPANTS A total of 43 residents and 20 homebound patients in a home-based primary care program. INTERVENTION A home-based primary care practice and accompanying curriculum for FM residents was developed and implemented to improve learners' confidence and skills to perform home visits. MEASUREMENTS A 10-question survey with a 4-point Likert scale and open-ended responses. Written resident reflections following home visits. RESULTS Over 3 years, 43 unique respondents completed a total of 79 surveys evaluating attitudes, skills, and barriers to home care. Some residents may have completed the survey more than once at different stages in their training. Overall, 86% are interested in home visits in future practice, and 78% of survey responses indicated an increased likelihood to perform home visits with more training. Learners with two or more home visits reported significantly improved confidence. Themes across all resident reflections included social determinants of health, patient-physician relationship, patient-home assessment, patient autonomy/independence, and physician wellness/attitudes. Residents described how home visits encourage more holistic care to improve outcomes for patients who are homebound. CONCLUSION Our home visit curriculum provided new learning, an enhanced desire to practice home-based primary care, improved learner confidence, and could help residents meet the need of a growing population of adults who are homebound. J Am Geriatr Soc 68:852-858, 2020.

Background: Smoking is the leading preventable cause of morbidity and mortality in the United States. Primary care providers (PCPs) have a unique opportunity to engage patients to quit smoking, but to be effective, clinicians must be able to personalize evidence-based interventions that are useful and appealing to patients in a time efficient manner. We pilot tested a novel iPad application (app), called e-Quit worRx™, designed to enhance patient-centered shared-decision making (SDM) about smoking cessation, with the primary goal of determining feasibility in primary care offices. Methods: A total of 73 patients from three offices within a local diverse primary care network were enrolled in a pragmatic single crossover-controlled trial. The decision aid app was incorporated into current smokers’ waiting time for their PCP in the exam room, and their PCP reviewed their personal responses and selections to finalize treatment choices. Mixed methods were used in the evaluation and the primary outcomes were app feasibility in primary care and enhanced SDM. Results: Our app was determined to be feasible for use in primary care for both patients and PCPs. It significantly increased time spent discussing smoking cessation with their PCP and the likelihood that a decision was made at the time of the visit. While not significant, mean differences were observed in other study measures including SDM, decisional conflict, quality of patient-provider communication, and stage of change progression at 12 weeks post-trial. Conclusions: We created a usable and acceptable iPad app-based decision aid for use in primary care offices. The design process presented several challenges including integration into a clinical setting. Despite these challenges, we successfully ran a pragmatic pilot trial in three primary care offices using a technology novel to many of the users.

Based on the adverse consequences and inadequate evidence of effectiveness for long-term opioid therapy (LOT), the CDC developed recommendations to decrease the use of LOT and morphine equivalent dose (MED) for patients receiving LOT. However, the majority of these patients report that opioid medication is significantly beneficial for pain management and are hesitant to reduce/decrease its use. Compounding the problem is poor access to non-pharmacologic therapies for many patients due to insurance reimbursement structures and limited pain-service availability. EMPOWER is an intent-to-treat, two-arm, open-label, randomized controlled trial evaluating a web-based self-management chronic pain program (E-Health) that has been found to reduce self-reported MED, while also decreasing pain, in two randomized controlled trials. Approximately 400 chronic pain patients receiving LOT at a daily average prescribed MED ≥ 20 mg at one of two U.S. healthcare systems, located in North Carolina and Ohio, will be randomized in a 1:1 ratio to treatment as usual (TAU) or TAU plus E-Health (E-Health+). TAU consists of LOT from a prescribing clinician. E-Health+ participants are provided with a 4-month E-Health subscription (active treatment phase). All participants will complete web-based self-report measures at baseline, the end of the active treatment phase, and 6-months post-active treatment. Opioid prescription information will be collected from the participants' electronic health record (EHR) from baseline through 6 months post-active treatment. This paper describes design considerations for this unique trial which is conducted completely remotely, with no in-person visits, and utilizes the EHR for participant identification and primary outcome collection.

Background Partnering with patients and families is a crucial step in optimizing health. A patient and family advisory council (PFAC) is a group of patients and family members working together collaboratively with providers and staff to improve health care. Objective This study aimed to describe the creation of a PFAC within a family medicine residency clinic. To understand the successful development of a PFAC, challenges, potential barriers, and positive outcomes of a meaningful partnership will be reported. Methods The stages of PFAC development include leadership team formation and initial training, PFAC member recruitment, and meeting launch. Following a description of each stage, outcomes are outlined and lessons learned are discussed. PFAC members completed an open-ended survey and participated in a focus group interview at the completion of the first year. Interviewees provided feedback regarding (1) favorite aspects or experiences, (2) PFAC impact on a family medicine clinic, and (3) future projects to improve care. Common themes will be presented. Results The composition of the PFAC consisted of 18 advisors, including 8 patient and family advisors, 4 staff advisors, 4 resident physician advisors, and 2 faculty physician advisors. The average meeting attendance was 12 members over 11 meetings in the span of the first year. A total of 13 out of 13 (100%) surveyed participants were satisfied with their experience serving on the PFAC. Conclusions PFACs provide a platform for patient engagement and an opportunity to drive home key concepts around collaboration within a residency training program. A framework for the creation of a PFAC, along with lessons learned, can be utilized to advise other residency programs in developing and evaluating meaningful PFACs.

Background Smoking is the leading preventable cause of morbidity and mortality in the United States, killing more than 450,000 Americans. Primary care physicians (PCPs) have a unique opportunity to discuss smoking cessation evidence in a way that enhances patient-initiated change and quit attempts. Patients today are better equipped with technology such as mobile devices than ever before. Objective The aim of this study was to evaluate the challenges in developing a tablet-based, evidence-based smoking cessation app to optimize interaction for shared decision making between PCPs and their patients who smoke. Methods A group of interprofessional experts developed content and a graphical user interface for the decision aid and reviewed these with several focus groups to determine acceptability and usability in a small population. Results Using a storyboard methodology and subject matter experts, a mobile app, e-Quit worRx, was developed through an iterative process. This iterative process helped finalize the content and ergonomics of the app and provided valuable feedback from both patients and provider teams. Once the app was made available, other technical and programmatic challenges arose. Conclusions Subject matter experts, although generally amenable to one another's disciplines, are often challenged with effective interactions, including language, scope, clinical understanding, technology awareness, and expectations. The successful development of this app and its evaluation in a clinical setting highlighted those challenges and reinforced the need for effective communications and team building.

BACKGROUND Partnering with patients and families is a crucial step in optimizing health. A patient and family advisory council (PFAC) is a group of patients and family members working together collaboratively with providers and staff to improve health care. OBJECTIVE This study aimed to describe the creation of a PFAC within a family medicine residency clinic. To understand the successful development of a PFAC, challenges, potential barriers, and positive outcomes of a meaningful partnership will be reported. METHODS The stages of PFAC development include leadership team formation and initial training, PFAC member recruitment, and meeting launch. Following a description of each stage, outcomes are outlined and lessons learned are discussed. PFAC members completed an open-ended survey and participated in a focus group interview at the completion of the first year. Interviewees provided feedback regarding (1) favorite aspects or experiences, (2) PFAC impact on a family medicine clinic, and (3) future projects to improve care. Common themes will be presented. RESULTS The composition of the PFAC consisted of 18 advisors, including 8 patient and family advisors, 4 staff advisors, 4 resident physician advisors, and 2 faculty physician advisors. The average meeting attendance was 12 members over 11 meetings in the span of the first year. A total of 13 out of 13 (100%) surveyed participants were satisfied with their experience serving on the PFAC. CONCLUSIONS PFACs provide a platform for patient engagement and an opportunity to drive home key concepts around collaboration within a residency training program. A framework for the creation of a PFAC, along with lessons learned, can be utilized to advise other residency programs in developing and evaluating meaningful PFACs.

BACKGROUND Smoking is the leading preventable cause of morbidity and mortality in the United States, killing more than 450,000 Americans. Primary care physicians (PCPs) have a unique opportunity to discuss smoking cessation evidence in a way that enhances patient-initiated change and quit attempts. Patients today are better equipped with technology such as mobile devices than ever before. OBJECTIVE The aim of this study was to evaluate the challenges in developing a tablet-based, evidence-based smoking cessation app to optimize interaction for shared decision making between PCPs and their patients who smoke. METHODS A group of interprofessional experts developed content and a graphical user interface for the decision aid and reviewed these with several focus groups to determine acceptability and usability in a small population. RESULTS Using a storyboard methodology and subject matter experts, a mobile app, e-Quit worRx, was developed through an iterative process. This iterative process helped finalize the content and ergonomics of the app and provided valuable feedback from both patients and provider teams. Once the app was made available, other technical and programmatic challenges arose. CONCLUSIONS Subject matter experts, although generally amenable to one another’s disciplines, are often challenged with effective interactions, including language, scope, clinical understanding, technology awareness, and expectations. The successful development of this app and its evaluation in a clinical setting highlighted those challenges and reinforced the need for effective communications and team building.

Background. Urban Health Project (UHP) is a mission and vision- driven sum- mer internship at the University of Cincinnati College of Medicine that places first- year medical students at local community agencies that work with underserved populations. At the completion of their internship, students write Final Intern Reflections (FIRs). Methods . Final Intern Reflections written from 1987 to 2012 were read and coded to both predeter - mined categories derived from the UHP mission and vision statements and new categories created from the data themselves. Results. Comments relating to UHP's mission and vision were found in 47% and 36% of FIRs, respectively. Positive experiences outweighed negative by a factor of eight. Interns reported the following benefits: educational (53%), valuable (25%), rewarding (25%), new (10%), unique (6%), and life- changing (5%). Conclusions. Urban Health Project is successful in providing medical students with enriching experi- ences with underserved populations that have the potential to change their understanding of vulnerable populations.

Hospice provides a full range of services for patients near the end of life, often in the patient's own home. There are no published studies that describe patient safety incidents in home hospice care.The study objective was to explore the types and characteristics of patient safety incidents in home hospice care from the experiences of hospice interdisciplinary team members.The study design is qualitative and descriptive. From a convenience sample of 17 hospices in 13 states we identified 62 participants including hospice nurses, physicians, social workers, chaplains, and home health aides. We interviewed a separate sample of 19 experienced hospice leaders to assess the credibility of primary results. Semistructured telephone interviews were recorded and transcribed. Four researchers used an editing technique to identify common themes from the interviews.Major themes suggested a definition of patient safety in home hospice that includes concern for unnecessary harm to family caregivers or unnecessary disruption of the natural dying process. The most commonly described categories of patient harm were injuries from falls and inadequate control of symptoms. The most commonly cited contributing factors were related to patients, family caregivers, or the home setting. Few participants recalled incidents or harm related to medical errors by hospice team members.This is the first study to describe patient safety incidents from the experiences of hospice interdisciplinary team members. Compared with patient safety studies from other health care settings, participants recalled few incidents related to errors in evaluation, treatment, or communication by the hospice team.

PURPOSE The clinician-colleague relationship is a cornerstone of relationship-cen- tered care (RCC); in small family medicine offices, the clinician-medical assistant (MA) relationship is especially important. We sought to better understand the relationship between MA roles and the clinician-MA relationship within the RCC framework. METHODS We conducted an ethnographic study of 5 small family medicine offices (having

BACKGROUND A single self-rated health (SRH) question is associated with health outcomes, but agreement between SRH and physician-rated patient health (PRPH) has been poorly studied. We studied patient and physician reasoning for health ratings and the role played by patient lifestyle and objective health measures in the congruence between SRH and PRPH. METHODS Surveys of established family medicine patients and their physicians, and medical record review at 4 offices. Patients and physicians rated patient health on a 5-point scale and gave reasons for the rating and suggestions for improving health. Patients' and physicians' reasons for ratings and improvement suggestions were coded into taxonomies developed from the data. Bivariate relationships between the variables and the difference between SRH and PRPH were examined and all single predictors of the difference were entered into a multivariable regression model. RESULTS Surveys were completed by 506 patients and 33 physicians. SRH and PRPH ratings matched exactly for 38% of the patient-physician dyads. Variables associated with SRH being lower than PRPH were higher patient body mass index (P = .01), seeing the physician previously (P = .04), older age, (P < .001), and a higher comorbidity score (P = .001). Only 25.7% of the dyad reasons for health status rating and 24.1% of needed improvements matched, and these matches were unrelated to SRH/PRPH agreement. Physicians focused on disease in their reasoning for most patients, whereas patients with excellent or very good SRH focused on feeling well. CONCLUSIONS Patients' and physicians' beliefs about patient health frequently lack agreement, confirming the need for shared decision making with patients.

The use of chronic opioids for patients with chronic nonmalignant pain (CNMP) is a common problem for family physicians, yet little is known about the management of CNMP in family medicine offices.Twenty one physicians at 8 practices of the Cincinnati Area Research Group (CARinG) network completed 25 to 30 modified Primary Care Network Survey 2 surveys. Each survey contained the question, "To your knowledge, does this patient have chronic (3 months) pain, even if they are not being seen for pain today?" Chart reviews of all patients identified as having chronic pain were performed to examine assessment, management, and monitoring of chronic opioids. Ten of these physicians and 10 office nurses or medical assistants were interviewed about caring for patients with chronic pain.Primary Care Network Survey 2 questionnaires were completed for 533 patients, 138 (26%) of which had CNMP, and 65 (47%) of those were taking chronic opioids; 25% of patients taking chronic opioids had a urine drug screen and 22% had an opioid contract in the chart. Patients with CNMP who were taking chronic opioids were more likely to be younger (54 vs 59 years; P = .003), have a coexisting mental health diagnosis (69% vs 44%; P = .005), and have assessments for pain (P = .031), function (P = .003), and psychological distress (P.001) and a second opinion (P = .001) in the chart than did patients with CNMP who were not taking opioids. Physicians described suspicion of patients as a primary difficulty in prescribing or considering chronic opioids; they also expressed interest in practicing evidence-based CNMP care, but there was little teamwork between physicians and medical assistants caring for patients with CNMP who were taking chronic opioids.Chronic opioids are frequently prescribed to patients with CNMP. Although patients taking opioids have better documentation of pain assessments and management, care for all patients with CNMP fell short of evidence-based guidelines and was primarily performed by the physician alone.

OBJECTIVES/SPECIFIC AIMS: As multidisciplinary, interdisciplinary, and transdisciplinary research has become imperative to solving the complex problems of contemporary healthcare, teaching researchers how to create and maintain high-functioning and innovative teams has also become paramount. In Fall 2016, the Center for Improvement Science (CIS) core, in collaboration with the Translational Workforce Development (TWD) core, at the Cincinnati Center for Clinical & Translational Science & Training (CCTST) began offering training in Team Science in an effort to better prepare researchers for collaborative work. Since then, the CIS has expanded Team Science education into a multifaceted and adaptable curriculum that includes workshops, team consultations, Grand Rounds, grant writing assistance, grant review, train-the-trainer, and a graduate-level course. METHODS/STUDY POPULATION: Over almost 2 years, we have offered 9 unique workshops attended by individuals from the University of Cincinnati, UCHealth, and Cincinnati Children’s Hospital Medical Center. Recruitment was primarily accomplished via email invitations. Topics ranged from introductory team science issues such as Creating Teams, Team Effectiveness, and Team Leadership to more advanced team science areas such as Team Dysfunctions and Conflict Management. In addition, we have consulted with researchers on Team Science components of grant applications and served as grant reviewers for Team Science elements in a competitive, internal research funding program. We have developed tools and teaching strategies for faculty members tasked with teaching students about collaboration (train-the-trainer). And finally, we offered a graduate level course on Collaboration and Team Science. RESULTS/ANTICIPATED RESULTS: Over 250 participants attended our workshops and Grand Rounds, many at the faculty level, but we also had research staff and graduate students register. Content was very well-received, with workshop evaluations typically scoring in the high 4.5 and above range (on a 5-point scale, with 5 being the highest rating). The CIS team received (and accepted) at least 2 follow-up invitations from workshop participants to provide training to an additional team or group. We are tracking data on long-term effects of team science training and consultation, both in research productivity and team satisfaction/longevity. DISCUSSION/SIGNIFICANCE OF IMPACT: The goals of Team Science training at the Cincinnati CCTST are 2-fold: to provide practical knowledge, skills, and tools to enhance transdisciplinary collaboration and to promote systemic changes at UC, CCHMC, and UCHealth that support team science. After almost 2 years of training, team science is gaining traction among key leaders at our local institutions and a broader audience of researchers who see how collaborative practice can enhance their professions.

A clinical sample of 995 community dwelling women aged 55 and older were surveyed by telephone about their experience with psychological/ emotional, control, threat, physical, and sexual abuse. Nearly half of the women experienced at least one type of abuse since turning 55. Sizable proportions were victims of repeated abuse, and many experienced co-occurring abuse. Women who experienced any type of abuse were more likely to self-report negative health effects than those who were not abused. Health care and social service providers should routinely screen older women for psychological/emotional abuse at it often co-occurs with more severe forms of abuse.

Most advice to patients regarding advocating for their safety relates to hospital care and is not grounded in the patient experience. We developed a patient-centered intervention to train elderly patients to be self-advocates for safer care in ambulatory settings. We pilot-tested a 2-part intervention that 1) educated the elderly regarding their role in identifying and preventing common errors in primary care and 2) provided them with skills to improve communication with health care providers. Participants completed a validated 21-question Seniors Empowerment and Advocacy in Patient Safety (SEAPS) survey before and 2 to 3 months after participation. Paired sample t tests were used to measure the impact of the intervention at 2 periods. In addition, field notes of participant comments regarding the intervention were analyzed qualitatively using immersion and crystallization. The mean total SEAPS score of the 61 participants (mean age, 74.5 years) improved from 44.6 to 48.3 (range, 0-63; P < 0.001). All demographic groups (sex, race, education, and frequency of doctors' visits) showed significant improvement except those with more than a high school education. All participants acknowledged learning new skills and ideas, as well as new ways of organizing their own health care information. Participants noted needed improvements in the intervention related to the roles that others are asked to play. Although intensive in effort, this pilot intervention demonstrated that elderly patients can improve their beliefs and self-reported safety behaviors in the ambulatory setting. Further work is needed to confirm the most useful aspects of the training and assess its impact on error reduction.

Thirty-eight women who were in abusive relationships since age 55 years were interviewed to understand their abuse stories, ways of coping, and health care experiences. In responding to these questions, women described the nature of the abuse perpetrated by their elderly partners and tried to “make sense” of what they had experienced and to define “who” these men were. This took various forms, from personal theories about aging, to labels (ethnic stereotyping, demonizing, pathologizing) to characterizations of the abuser’s private versus public behaviors. The authors explore the implications these findings have for assisting the elderly victim and perpetrator.

PURPOSE: This study assessed the extent of different types of abuse, repeated and multiple abuse experiences among women aged 60 and older, and their effects on the women's self-reported health. DESIGN AND METHODS: A cross-sectional study of a clinical sample of 842 community-dwelling women aged 60 and older completed a telephone survey about type and frequency of abuse, self-reported health status and health conditions, and demographic characteristics. Bivariate and multivariate analyses were performed using SPSS 11.5 and STATA 7.0. RESULTS: Nearly half of the women had experienced at least one type of abuse-psychological/emotional, control, threat, physical, or sexual-since turning 55 years old. Sizable proportions were victims of repeat abuse. Many women experienced multiple types of abuse and experienced abuse often. Abused older women were significantly more likely to report more health conditions than those who were not abused. Women who experienced psychological/emotional abuse-alone, repeatedly, or with other types of abuse-had significantly increased odds of reporting bone or joint problems, digestive problems, depression or anxiety, chronic pain, and high blood pressure or heart problems. IMPLICATIONS: It is important that health care and service providers acknowledge psychological/emotional, control, threat, physical, and sexual abuse against older women and understand their health implications. In addition, it is important for providers to be trained in both aging and domestic violence services and resources. Language: en

Intimate partner violence (IPV) is a problem in older women, but older victims of IPV are often unidentified in the medical setting because providers think of IPV as a problem of younger women. The experiences of older women with IPV are unknown. This study reports on the healthcare experiences and needs of older victims of IPV.Interviews were conducted with 38 women55 years who responded to an advertisement recruiting "women who had been in an abusive relationship since age 55." Interviews were audiotaped, transcribed, and analyzed for themes.The median age of participants was 58 years (range 55-90). The majority were Caucasian with annual incomes over dollar 40,000. The median relationship length was 24 years (range 2-67), and 39% remained in their abusive relationships. About half had discussed IPV with a healthcare provider. The themes that were identified included disclosure about IPV and both negative and positive experiences with healthcare providers. Reasons for nondisclosure were similar to those of younger women but were compounded by the generational mores of privacy about domestic affairs and society's lack of understanding and resources for IPV. Some of the women who disclosed IPV to their providers felt discounted and unsupported. Others reported receiving valuable help, including empathy, referrals to resources, assistance in naming the abuse, linking the stress of IPV to health, and respect for their decisions to continue their abusive relationships.Older women victims have difficulty initiating discussions about IPV with their providers. Providers are encouraged to identify signals of potential abuse and to create privacy with all patients to discuss difficult issues, such as IPV, and to be knowledgeable about appropriate referrals.

Background: Intimate partner violence (IPV) is common in primary care; 11% to 22% of women experienced physical abuse in the past year. Older women experience IPV as well, but it is often undetected. This study examined primary care providers’ awareness about IPV in older women, including their screening practices and management. Methods: Interviews and focus groups were conducted with 44 primary care providers. Thematic analysis was used to identify common themes. Results: Providers fell along a continuum of thoroughness for identifying and managing IPV in older women, ranging from suboptimal to thorough identification of IPV and suboptimal to thorough management of the patient. In addition to the barriers commonly reported about IPV screening in younger women, providers described limited understanding of the diagnoses commonly associated with IPV, frustration with older women’s unwillingness to disclose problems and ask for help, and limited community services that accommodate older women with IPV. Providers recommended that communities sponsor public awareness campaigns about IPV as a problem for all women and that aging and IPV agencies work together. Conclusions: Continued provider training about IPV should include information on identifying older victims and appropriate management options. Participants stressed the importance of community efforts to raise awareness and improve resources available for older women who are victims of IPV.

To understand women’s reasons for continuing long-term abusive relationships, inter-views were conducted with 36 women who were over the age of 55. These women matured during times of sweeping social changes with the feminist, battered women’s, and elder abuse movements. Reasons for remaining were organized into three categories: cohort, period, and aging effects. Cohort effects included reasons similar to those of younger women such as lacking education or job skills. Period effects related to efforts to seek help early in the abusive relationship and receiving little assistance from society’s social institutions. Finally, aging effects dealt with how the health challenges of physical age limited options.

Over the last ten years, a growing body of literature has examined services for older women who are abused. This article describes the results from a statewide survey of Ohio's domestic violence (DV) centers' programs and services for older women. Surveys were mailed to all Ohio DV centers in spring 2002, with a follow-up mailing and phone calls, yielding a 73% response rate. Seventy-eight percent had sheltered as least one woman over 55 years old during 2001. Other programs were serving some older women as well. While less than half of the centers educated their staff and volunteers about the needs of older women, 57% had provided training to aging agencies about DV. More collaboration and cross training with aging agencies was recommended to better meet the needs of older women.

To develop a survey to measure seniors' embracement of ambulatory patient safety self-advocacy behaviors, the Senior Empowerment and Advocacy in Patient Safety (SEAPS) survey.Content was developed by review of published recommendations combined with interviews and focus groups with community members; items were generated for subscales based on the health belief model (HBM). Psychometric characteristics were assessed by cluster and correlation analyses on a pilot test of 143 community dwelling seniors; the ability of the subscales and demographic variables to predict reported behavior was investigated by multiple regression.The four subscales of the SEAPS were outcome efficacy (OE), attitudes (ATT), self-efficacy (SE) and behaviors (BEH). Cronbach alphas were 0.74 for ATT, 0.79 for BEH, and 0.91 for OE and SE. Analysis of variance showed that there were no differences in any subscale score by race, education level or frequency of doctor visits, but women were noted to have significantly higher scores (p.01) on the ATT and SE subscales and for the total of all the scales. Multiple regressions showed that SE significantly predicted self-reported behavior (p.001). OE was a significant predictor for whites (p.001) but not for African-Americans (p=.24).We have developed a short, 21-item self-administered survey to assess seniors' views about their participation in safety tasks.We believe the SEAPS shows promise to be a tool for evaluating interventions and training programs aimed at improving seniors' self-advocacy skills. Effective interventions may improve the involvement of patients in their own safety in the clinical setting.

Background Physicians are being asked to report errors from primary care, but little is known about how they apply the term "error." This study qualitatively assesses the relationship between the variety of error definitions found in the medical literature and physicians' assessments of whether an error occurred in a series of clinical scenarios. Methods A systematic literature review and pilot survey results were analyzed qualitatively to search for insights into what may affect the use of the term error. The National Library of Medicine was systematically searched for medical error definitions. Survey participants were a random sample of active members of the American Academy of Family Physicians (AAFP) and a selected sample of family physician patient safety "experts." A survey consisting of 5 clinical scenarios with problems (wrong test performed, abnormal result not followed-up, abnormal result overlooked, blood tube broken and missing scan results) was sent by mail to AAFP members and by e-mail to the experts. Physicians were asked to judge if an error occurred. A qualitative analysis was performed via "immersion and crystallization" of emergent insights from the collected data. Results While one definition, that originated by James Reason, predominated the literature search, we found 25 different definitions for error in the medical literature. Surveys were returned by 28.5% of 1000 AAFP members and 92% of 25 experts. Of the 5 scenarios, 100% felt overlooking an abnormal result was an error. For other scenarios there was less agreement (experts and AAFP members, respectively agreeing an error occurred): 100 and 87% when the wrong test was performed, 96 and 87% when an abnormal test was not followed up, 74 and 62% when scan results were not available during a patient visit, and 57 and 47% when a blood tube was broken. Through qualitative analysis, we found that three areas may affect how physicians make decisions about error: the process that occurred vs. the outcome that occurred, rare vs. common occurrences and system vs. individual responsibility Conclusion There is a lack of consensus about what constitutes an error both in the medical literature and in decision making by family physicians. These potential areas of confusion need further study.

Little is known about how older women cope in long-term abusive intimate relationships. Understanding their coping strategies may give insight into how to further support their effective coping efforts. Interviews were conducted with 38 women older than age 55 years. Grounded theory analysis demonstrated that women who remained in their abusive relationships employed mainly cognitive (emotion-focused) strategies to find meaning in a situation that was perceived as unchangeable. By reappraising themselves, their spouses, and their relationships they refocused energies in certain roles, set limits with their abusers, and reached out to others (friends, family, and community organizations). Some women appeared to thrive, others merely survived, but all maintained the appearance of conjugal unity.

Identify the incidence and prevalence of intimate partner violence (IPV) in women over 55 years of age in primary care offices.Telephone survey conducted between March and June 2003 by trained female interviewers who gathered self-report information about health and abuse.A total of 3,636 women over 55 years of age had at least 1 visit in the past 12 months to primary care offices affiliated with an academic center in Southwestern Ohio were contacted by phone; 995 were deemed competent and completed the interview. INTERVENTION/INSTRUMENT: Thirty-eight page instrument that explored health, history of psychological (controlling behavior and threat of physical harm), physical, and sexual abuse since age 55 years. Interviews lasted 20 to 45 min.The mean age was 69 years (SD 8.35). Physical abuse in intimate relationships was reported by 1.52% since age 55 years (prevalence) and 0.41% in the past year (incidence). Prevalence and incidence rates for sexual abuse were 2.14% and 1.12%, threat of physical harm 2.63% and 1.62%, respectively. Less than half of the victims told someone else about the abuse. The mean number of health conditions was 3.84 for victims and 3.21 for nonvictims (P.055) with significantly larger percentages of IPV victims reporting problems with chronic pain and depression.Physical and sexual abuse by an intimate partner does occur in women over 55 years, but rates are lower than those of younger women. Health care providers are reminded to think about IPV in older women and to ask about abuse as disclosure is rare.

Objectives 1. To describe the personal, emotional burden experienced by residents when learning to care for seriously ill and dying patients early in their residency training. 2. To describe the positive effects on residents’ sense of support and positive learning opportunities resulting from a new interdisciplinary palliative care consult service in their teaching hospital. 3. To generate discussion with conference attendees during poster sessions regarding additional potential educational benefits for resident physicians created by the presence of interdisciplinary palliative care teams.

This article reports on the Ohio Quality Assurance Project, a two year demonstration. The project developed a model quality assurance system for in-home supportive services funded by Title III of the Older Americans Act including home health aide, personal care, homemaker, transportation and escort, home delivered meals, chore and home maintenance services. Using four planning and service areas in the state of Ohio comprising over 40 countries, the project developed, implemented and evaluated quality assurance standards and monitoring activities for Older Americans Act services. In addition, a second part of the project included in-depth case studies with consumers receiving in-home care.