Geriatrics Models of Care - Bringing 'Best Practice' to an Aging America, 2e (July 1, 2024)_(3031562038)_(Springer)

Following the success of the previous edition, the second edition of Geriatrics Models of Care is the definitive resource for systems-based practice improvement for the care of older adults. Several new models of care have been published in the last eight years, new outcomes have emerged to better understand the impact of existing models, and with the rise of the Age-Friendly Health Systems movement, promoting organized efforts to prepare our health care settings for older individuals is of more importance than ever. The second edition is organized based on the practice setting along a continuum of care: hospital, transitions from hospital to home, outpatient settings, and the emergency department. This book also highlights long-term care models, which is an important part of the continuum of care for older Americans. Further, this edition features models that address the needs of vulnerable populations. This new section will describe a spectrum of programs for older adults who have Alzheimer’s disease or Parkinson’s disease. Other models describe best practices for older adults undergoing surgery or those who want to remain functioning independently in their home. A defining feature of this book is that each chapter follows a standard template: 1) the challenge which led to the model; 2) the patient population served; 3) core components of the intervention; 4) the role of interdisciplinary health professionals; 5) evidence to support the intervention; 6) lessons learned in the implementation and dissemination of the model; 7) implications for family caregivers, and communities (particularly underserved and diverse communities); and 8) how each model will provide care across the continuum during an entire episode of care. In addition, each chapter features a “call out” box with practical tips for implementing the model. Foreword Preface: Excellent Systems of Care for Entire Communities of Older Adults Contents Editors and Contributors About the Editors Contributors Part I: Hospital Based Models of Care 1: Acute Care for Elders Introduction The Challenge: Hospital-Associated Disability Core Components of an ACE Unit ACE Unit Interprofessional Team Members, Roles, and Rounds Members and Staffing Ratios Roles and IPT Rounds Implications for Patients, Family Care Partners, and Communities Patient Population Served ACE Unit Model and Health Disparities ACE Unit Outcomes Process and Clinical Outcomes Health Care Utilization and Cost Outcomes Dissemination of the ACE Model Alternative ACE Models in the Acute Care Setting Next Steps in the ACE Model of Care Dissemination ACE Unit Model Alignment with Cross-Continuum Value-Based Care Developing and Sustaining an ACE Unit Model of Care: Lessons Learned Development/Sustainment Strategies Barrier Mitigation Conclusion References 2: Optimizing Age-Friendly Hospital Care: American Geriatrics Society CoCare Hospital Elder Life Program (HELP) Overview Original Age-Friendly Hospital System Model Program Structure and Interventions Patient Population Inclusion Criteria Exclusion Criteria Core Components of the Intervention Role of the HELP Interdisciplinary Team Elder Life Nurse Specialist Key Responsibilities of the ELNS Elder Life Specialist Key Responsibilities of the ELS Geriatrician Key Responsibilities of the HELP Geriatrician Volunteers Interdisciplinary Rounds Staff Overview Quality Assurance Procedures Quality Assurance to Improve Intervention Adherence Quality Assurance to Improve Staff Role Functioning Quality Assurance of Volunteer Performance Patient-Family Survey Ongoing Program Quality Improvement Strategies to Improve Adherence General Strategies Volunteer-Related Strategies HELP Outcomes Potential Outcomes to be Tracked at HELP Sites Process Measures Clinical Outcomes Evidence for Efficacy and Cost-Effectiveness Efficacy Studies Cost-Effectiveness Studies Challenges to Implementation Challenges in Starting a Program Challenges in Sustaining HELP Surviving in Difficult Clinical Times HELP Dissemination Process Feasibility of Family Participation Integration of HELP with Other Geriatric Models of Care Future Directions Summary References 3: The Acute Care for Elders Consult Program Acute Care for Elders: Background and Introduction Challenge That Led to the Model Dysfunctional Syndrome: The ACE Prehabilitation Model Patient Population Served Core Components of the Intervention Role of the Interdisciplinary Healthcare Professionals: The ACE Team Evidence to Support the Intervention Lessons Learned with Implementation and Dissemination Implications for Underserved, Diverse Communities, and Their Caregivers Implications for Value-Based Payment Systems Medicare Rule Changes for Care Transitions and How ACE Principles Can Minimize the Impact on Hospitals Conclusions References 4: Nurses Improving Care for Healthsystem Elders (NICHE) The Challenge That Led to the Model Program History The Population Served Core Components of the Intervention Clinical Specialization Evidence-Based Practice Guidelines Transitions of Care Environment of Care and Integration of the Acute Care for Elders (ACE) Unit Principles Implementing the NICHE Model in Practice Settings Workforce Education and Role Development Documentation Systems and Integration into the Electronic Health Record (EHR) Role of the Interdisciplinary Health Professionals Evidence to Support the Intervention Geriatric Institutional Assessment Profile: Generating Data to Guide Program Implementation Nurse-Sensitive Quality Measures Evidence-Based Change Management Model Member Recognition and Voluntary Evaluation Program Lessons Learned in the Implementation and Dissemination of the Model Creating a Sustainable Business Model to Support National Program Office Activities Implications for Family Caregivers and Older Adults, Particularly Underserved How NICHE Provides Care Across the Continuum and Supports Value-Based Care Models Alignment with National Geriatric Quality Initiatives Conclusion References 5: Palliative Care as a Consultation Model Background Which Healthcare Problems Are Addressed by Palliative Care? Which Patients Will Be Best Served by Palliative Care? What Are the Barriers to the Provision of Palliative Care? Workforce Challenges Perception of Palliative Care What Are the Benefits of Palliative Care? Quality Outcomes Cost Outcomes How Does Palliative Care Help Align the Care Delivered to Patients with the Care They Desire? With So Many Choices, How Do Hospitals and Health Systems Know Which Model to Pick? Funding and Building a Program How to Get Buy-In from Health System Leaders How Do You Develop a Business Plan to Determine the Costs and Benefits of the Model? “What Can We Implement and How Can We Get It for the Least Cost?” Will the Care Be Paid for Under the Medicare Fee-for-Service Program and Who Will Bear the Costs as Health Systems Transition to Value-Based Purchasing? Developing a Program to Meet the Hospital’s Needs What Are the Key Components and How Does the Model Work? Who Are the Interdisciplinary Team Members? Social Work Spiritual Care Complementary Therapists How Do Interdisciplinary Team Members Work Together? Leveraging the Electronic Medical Record Can Adult Patients/Family Caregivers Be Involved in the Planning and Advising of the Model of Care? What Training Is Required for Providers? How Can the Fidelity of the Implementation Be Maintained? What Is the Role of the Geriatrician in Developing and Leading the Model? How Can Health Systems Integrate the Geriatrics and Palliative Medicine Practice Models to Provide a Portfolio of Strategies to Address the Needs of Patients? Monitoring Outcomes and Planning for Future Directions Is the Model Scalable? How Do We Know the Model Is Improving Care? What Are the Future Directions of Palliative Care Consultation Services? References 6: AGS CoCare®: Ortho: Orthogeriatrics Comanagement for Fragility Fractures Challenge That Led to the Model Patient Population Served Core Components of the Intervention Role of Interdisciplinary Health Professionals Evidence to Support the Intervention Lessons Learned in the Implementation and Dissemination of the Model Challenges and Lessons Learned Challenge 1: Obtaining Health System Leadership Buy-In Lesson 1: The Importance of a Business Plan Challenge 2: Getting Things Done Lesson 2: Creation of a Steering Committee Challenge 3: Lack of Standardization of Care Across Diverse Hospital Sites Lesson 3: Standardized Order Sets and Documentation Challenge 4: Geriatrician Shortage Lesson 4: Hospitalists as Co-managers Challenge 5: Workflow Variability Lesson 5: Service Agreements Challenge 6: Educational Challenges Lesson 6: Multimodal Education Strategy Challenge 7: Maintaining Site Enthusiasm and Engagement Lesson 7: Quality Assurance Implications for Family Caregivers and Communities (Particularly Underserved and Diverse Communities) Describe Experiences/Recommendations When Caring for Older Adults from Other Demographics/Ethnicities How Each Model Provides Care Across the Continuum During an Entire Episode of Care References 7: Geriatric Surgical Hospital Care Model Introduction The Challenge That Led to the Model Patient Population Served Core Components of the Intervention Goals and Decision-Making (Standards 5.1–5.5) Preoperative Work-Up (Standards 5.6–5.9) Postoperative Management (Standards 5.10–5.16) Transitions of Care (Standards 5.17–5.18) Institutional and Programmatic Support Structure (Standards 1–4 and 6–9) The Role of Interdisciplinary Health Professionals Evidence to Support the Intervention Lessons Learned in the Implementation and Dissemination of the Model Implications for Family Caregivers and Communities How Each Model Will Provide Care Across the Continuum During an Entire Episode of Care References 8: The STRIDE Program: Getting Hospitalized Veterans Back on Their Feet Introduction Clinical Challenges That Led to the Development of the STRIDE Program How to Determine Which Patients Are Best Served by the STRIDE Program What Are the Core Components of the STRIDE Program? Roles of Interdisciplinary Health Professionals Implementing the STRIDE Program Evidence to Support the Implementation of the STRIDE Program Research on STRIDE Effectiveness Evidence from Other Hospital Mobility Programs Cost of Delivering STRIDE Lessons Learned During the Implementation and Dissemination of the STRIDE Program Leadership Support Is Essential Flexibility Is Key to Sustainment Interdisciplinary Approach Implications of the STRIDE Program in Real-World Settings Key Considerations for Health Systems Age-Friendly Equitable Care Delivery How the STRIDE Program Provides Care Across the Continuum References Part II: Models to Address the Needs of Older Adults in Transition from Hospital to Home 9: Care Transitions Intervention and Other Non-nursing Home Transitions Models Background Care Gaps in Transitional Care Sites of Post-hospitalization Care Factors Contributing to Adverse Events During Care Transitions Communication Across Care Settings Common Themes in Optimal Care Transitions Patient/Caregiver Self-Management Medication Management and Medication Reconciliation in Care Transitions Roles of Interdisciplinary Team Members, Patients, and Families in Care Transitions Interventions to Improve Care Transitions Post-hospitalization Transitional Care Model Care Transitions Intervention Re-Engineered Discharge Bridging the Discharge Gap Effectively (BRIDGE) Program Coordinated—Transitional Care (C-TraC) Care Transition Intervention Targeting Patients Experiencing Low Socioeconomic Status Health Information Technology as a Tool to Assist with Care Transitions Electronic Health Records and Discharge Summaries Telehealth in Transitional Care Telehealth and Readmissions Conclusions References 10: Project BOOST®: A Comprehensive Program to Improve Discharge Coordination for Geriatric Patients Project BOOST® Interventions and Tools in Project BOOST® Effectiveness of Project BOOST® Implementation of Project BOOST® Planning and Development Process Key Processes and Steps in Project BOOST® (Fig. 10.3) Evaluation References 11: Connect-Home: Transitional Care in Skilled Nursing Facilities Introduction Challenges of Care Transitions from SNFs to Home and Other Destinations Connect-Home Transitional Care Connect-Home and Interdisciplinary Team Evidence Supporting Connect-Home Efficacy Care of Diverse Populations Lesson Learned Implementing Connect-Home Value-Based Payment Conclusion References Part III: Outpatient Care Models 12: The GRACE Model Background and Conceptual Model GRACE Team Care Overview Key Components In-Home Geriatric Assessment Individualized Care Plan and GRACE Protocols GRACE Interdisciplinary Team Conference Primary Care Physician Collaboration Care Plan Implementation Proactive Care Management and Care Coordination GRACE Interdisciplinary Team An Evidence-Based Approach GRACE Randomized Controlled Trial Replication Experience The Business Case for GRACE Lessons Learned Keys to Success Facilitators to Successful Implementation GRACE Training and Resource Center References 13: “Guided Care” for People with Complex Care Needs Introduction The Guided Care Model Patient and Family Caregiver Assessment Care Planning Promotion of Self-Management Monitoring Patients’ Symptoms and Adherence Coordinating Providers of Care Smoothing Transitions Between Sites of Care Supporting Family Caregivers Accessing Community Resources Guided Care Outcomes Selection of Provider Teams Recruitment of Nurses Recruitment of Patients Randomization Results Lessons Learned Requirements for Implementing Guided Care Steps Toward Implementing the Guided Care Model Technical Assistance in Adopting Guided Care References 14: Chronic Disease Self-Management Education: Program Success and Future Directions Introduction Setting Problem to be Addressed Patients Who Benefit Model Overview Program Fidelity Interdisciplinary Health Professionals Evidence Challenges and Lessons Learned Care Across the Continuum References 15: The Patient-Centered Medical Home Without Walls: Clinicians and Community Health Workers Partner to Provide Care for Frail Older Adults—The CARIÑOS Model The Challenges That Led to the Model Challenges of the PCMH’s Limitations Challenges Due to COVID-19 Patient Population Served and Our Personnel Core Components of the Model Role of Interdisciplinary Health Professionals Evidence to Support the Model Utilization Costs CMS-HCC Score Data Extraction and Analysis Methods Lessons Learned in Implementing and Disseminating the Model How Did We Get There? Key Questions and Activities to Accomplish Tips for Adapting and Implementing the CARIÑOS Model Implications for Family Caregivers and Underserved/Diverse Communities How This Model Provides Care Across the Continuum in the Context of Value-Based Payment Systems Summary Appendix 1: Tips for Adapting and Implementing the CARIÑOS Model in Your Primary Care Practice References 16: Models of Integrated Behavioral and Mental Health in Primary Care Introduction Geriatric Depression and Anxiety Collaborative Care (CoCM) What Is the Collaborative Care Model? Case Illustration Collaborative Care Model in the Literature Primary Care Behavioral Health (PCBH) Integration Case Illustration Primary Care Behavioral Health Model in the Literature Implications Conclusions Resources References 17: Hospital at Home Introduction The Problems Addressed by HaH Hospital Care Is Expensive and Not Always the Best Healing Environment Trends That Favor Alternatives to Traditional Hospital Care What Is HaH? The HaH Model Conditions that Can Be Treated in HaH How the HaH Model Works Family Caregivers Emerging Role and Use of Technology in HaH Evidence on HaH Implementation and Dissemination of HaH Pre-COVID-19 Pandemic The COVID-19 Pandemic and HaH Dissemination Regulatory Home for HaH How to Build a HaH Program? Diverse Populations and Healthcare Equity in HaH The Future State References 18: Home-Based Primary Care: Independence at Home and the VA Challenges that Led to the Model Description of the Interventions Results Lessons Learned and Future Directions References 19: Outpatient Geriatric Evaluation and Management Introduction Model of the CGA Challenges Leading to the CGA Who Should Be Referred for a CGA? Functional Status Geriatric Syndromes Chronic Illnesses Specialty Uses of the CGA Goals of the CGA Current Medical Illnesses Functional Status Frailty Gait and Balance Assessment Fall Risk Polypharmacy/Medication Review Cognitive Status Mood and Psychological Disorders What Matters Most Advance Directives/End-of-Life Decisions Social Circumstances and Social Determinants of Health Interdisciplinary Team Effectiveness and Outcomes of Outpatient CGA/GEM Financial Considerations Conclusion References 20: Stepping On: A Community-Based Fall Prevention Program The Stepping On Model Background Stepping On Program in the USA Lessons Learned in Implementation and Dissemination of the Model Need for Effective Implementation Sustainability Tailoring for Underserved Communities Financial Models to Support Stepping on Implementation Conclusion References 21: Outpatient Care Models: The Gerofit Model of Care for Exercise Promotion in Older Adults Introduction Patient Population Served Core Components Role of Interdisciplinary Health Professionals Evidence to Support Intervention Improved Function, Morbidity, and Mortality Patient-Reported Outcomes Health Services Access Lessons Learned in Implementing and Dissemination Staffing Requirements Sustainability Implications for Family Caregivers and Communities How the Gerofit Model Provides Care across the Continuum References 22: Fall Prevention Intervention Model in Primary Care: STRIDE Challenge that Led to the Model Patient Population Served Core Components of the STRIDE Intervention Model Engagement Promotion Care Processes Fidelity Optimization Evidence to Support the STRIDE Intervention STRIDE Trial Design Results Summary of Findings Lessons Learned in the Implementation and Dissemination of the STRIDE Intervention Model Lessons Learned from STRIDE-Related Literature Lessons Learned from Ancillary and Ad Hoc STRIDE Research Implications for Underserved and Diverse Individuals, Care Partners, and Communities Conclusion References 23: Geriatrics Models of Care Second Edition: CAPABLE Introduction: How to Keep Seniors in Their Homes As Long as Possible Core Components and Program Structure of CAPABLE Enrollment Criteria for CAPABLE Roles of Interprofessional Team Members Evidence-Based Outcomes of Intervention Scaling and Sustaining the CAPABLE Model Implications for Families, Community Funding, and Underserved Communities CAPABLE Care and Value-Based Models Summary References Part IV: Emergency Department Models 24: Geriatric Emergency Departments Challenge that Led to the Model Patient Population Served Core Components of the Models Role of Interdisciplinary Health Professionals Evidence to Support the Models Lessons Learned in Implementation and Dissemination Implications for Family Caregivers and Communities Models within the Healthcare Continuum References 25: Emergency Department Models: EQUiPPED Challenges that Led to the Model Population Served Core Components of the Intervention Role of Interdisciplinary Health Professionals Evidence to Support the Intervention Lessons Learned in the Implementation and Dissemination of the Model Implications for Family Caregivers and Communities, Particularly Underserved and Diverse Communities How the EQUiPPED Model Will Influence Care across the Continuum, Particularly in the Context of Value-Based Payment Systems Conclusion References 26: Improving Older Adult Care Transitions, from the Emergency Department to Home: The Community Paramedic Transitions Intervention Background Community Paramedic Transitions Intervention Overview Core Components of the CPTI-ED Inclusion and Exclusion Criterion for the Older Adult ED Patient Population CPTI-ED Adaptations and the Role of Community Paramedicine The Effectiveness and Implementation of the CPTl-ED Implication for Family Caregivers and Community at Large How the CPTI-ED Provides Care in the Context of Value-Based Payment Final Thoughts References Part V: Long Term Care Models 27: OPTIMISTIC and Beyond: Programs to Improve Nursing Home Care and Reduce Avoidable Hospitalizations Background OPTIMISTIC Model Overview Medical Care Palliative Care Transitional Care Staff Education and Training Outcomes Evolution to Probari Lessons Learned from Implementation of Care Models in the Nursing Home Implications for Value-Based Payment Systems Conclusion References 28: The INTERACT Quality Improvement Program The Challenge that Led to the Model Core Components of the Intervention Resources for Implementation Overview of INTERACT Tools and Their Use in Everyday Care Medication Worksheet Advance Care Planning Tools Communication Tools Decision Support Tools Quality Improvement Tools The Role of Interprofessional Teamwork Evidence to Support the Intervention Lessons Learned in the Implementation and Dissemination of the Model Implications for Family Caregivers and Communities How Interact Can Provide Care across the Continuum, in the Context of Value-Based Payment Systems Summary References 29: Program of All-Inclusive Care for the Elderly (PACE) Model Introduction History Population Served PACE Service Coordination and Delivery The Interdisciplinary Team (IDT) Setting Interdisciplinary Team Operation Transitional Care Accessible Housing PACE Funding Regulatory Framework PACE Growth and Expansion PACE Outcomes PACE Response to COVID-19 Pandemic Conclusion References 30: Care Beyond Clinical: The Green House Model for Reimagining Nursing Homes Responding to Pervasive Nursing Home Challenges: Developing the Green House Model Core Components of the Intervention Role of Interdisciplinary Health Professionals Population Served Empirical Evidence for the Green House Model Lessons Learned: Implementation and Dissemination of the Model The Value-Based Opportunity References 31: The DICE Model Challenge That Led to the Model and the Population Served Core Components of the Intervention Describe Investigate Create Evaluate Role of Medications in the DICE Approach Role of Interdisciplinary Health Professionals Evidence to Support the Intervention Lessons Learned in the Implementation and Dissemination of the Model Implications for Family Caregivers and Communities How DICE Provides Care Across the Continuum, Particularly in the Context of Value-Based Payment Systems References Part VI: Models Which Address the Needs of Unique Patient Populations 32: The UCLA Alzheimer’s and Dementia Care (ADC) Program for Comprehensive, Coordinated, and Patient-Centered Dementia Care Challenge That Led to the Model The Patient Population Served Core Components of the Intervention Role of Interdisciplinary Health Professionals Evidence to Support the Intervention Lessons Learned in the Implementation and Dissemination of the Model Implications for Family Caregivers and Communities (Particularly Underserved and Diverse Communities) How Each Model Will Provide Care Across the Continuum, Particularly in the Context of Value-Based Payment Systems References 33: The Indiana Aging Brain Care Project Background Challenge That Led to the ABC Project The Healthy Aging Brain Center Population Served in the HABC Program Core Components and Interdisciplinary Roles of HABC Program Initial Assessment Phase Follow-Up Phase Evidence and Lessons Learned from HABC The Aging Brain Care Medical Home Population Served by the ABC Med Home Core Components and Interdisciplinary Roles of HABC Program Initial Assessment Phase Follow-Up Phase Acute Care Transition Phase Lessons Learned from the HABC Program Sustaining Value: Plans for the Future References 34: The University of Wisconsin-Madison Wisconsin Alzheimer’s Institute Dementia Diagnostic Clinic Network Background Model Overview Preclinical Activity Evaluation Components Clinical Interpretation and Diagnostic Impression Recommendations and Treatment Plan Development with Patient and Support System Post-clinic Activity The Role of Interdisciplinary Health Professionals Evidence Associated with the Intervention Lessons Learned Application of the Model in Underserved and Diverse Communities Serving Vulnerable Communities in Milwaukee, WI Serving the Hispanic/Latino Community in Milwaukee, WI Conclusion References 35: The VA COACH Program: A Longitudinal Dementia Care Model Focused on the Caregiver in the Home The Challenge That Led to the Model Patient Population Served Core Components of the Intervention Role of Interdisciplinary Healthcare Professionals Evidence to Support the Intervention Lessons Learned with Implementation and Dissemination Implications for Family Caregivers and Communities How the Model Provides Care Across the Continuum References 36: Emergency Department/Hospital-Based Elder Mistreatment Response Teams Introduction: Challenge That Led to the Model Patient Population Served Core Components of the Intervention: Overview of ED/Hospital-Based Elder Mistreatment Response Team Care Model and the Role of Interdisciplinary Health Professionals Differences Between VEPT and VESPA Evidence to Support the Intervention Ongoing and Future Research Dissemination and Implementation: Learning Lessons Implications for Family Caregivers and Communities Funding for Sustainability, Adding Value, and Providing Care Across the Continuum Conclusion References 37: Patient Priorities Care: Priorities Aligned Decision Making for Persons with Multiple Chronic Conditions Challenge That Led to the Model Patient Population Served Core Components of the Intervention Role of Interdisciplinary Health Professionals Evidence to Support the Intervention Lessons Learned in the Implementation and Dissemination of the Model Implications for Family Caregivers and Communities (Particularly Underserved and Diverse Communities) How Each Model Will Provide Care Across the Continuum, Particularly in the Context of Value-Based Payment Systems References 38: The Interdisciplinary Home Visit Program for Individuals with Advanced Parkinson’s Disease Challenge That Led to Our Model Patient Population Served New York-Based Home Visit Program (HVP): 2014–2017 Chicago-Based IN-HOME-PD Model: 2018–2020 Core Components of the Intervention Roles of the Interdisciplinary Health Professionals Evidence Supporting the Intervention Lessons Learned in the Implementation and Dissemination of the Model Implications for Family Caregivers and Diverse Communities How the Model Provides Care Across the Continuum, Particularly in the Context of Value-Based Payment Systems References 39: Adult Day Services: A Critical Community-Based Option to Enable Individuals to Stay at Home The Challenge Leading to Adult Day Services Populations Served by ADS Core Components of ADS The Interdisciplinary Care Team Evidence Supporting the Role of ADS Challenges and Lessons Learned ADS Within the Health Care Continuum References 40: Geriatric Models of Care: Perioperative Optimization of Senior Health (POSH) An “Old” Problem Leads to a New Paradigm Patient Population Served by the POSH Model Core Components of the Intervention Role of Interdisciplinary Health Professionals Evidence to Support the Intervention Lessons Learned in Implementation and Dissemination of the Model Implications for Family Caregivers and Communities How the Model Provides Care Across the Continuum References 41: Closing the Osteoporosis Treatment Gap with Bone Health and Fracture Liaison Services The Osteoporosis Treatment Gap Bridging the Gap: Development of the Fracture Liaison Service Model Evidence Base for FLS Model Nationally/Internationally Development of a Virtual Regional VA Bone Health Service Role of FLS in Managing Other Geriatric Syndromes Role of FLS in Primary Fracture Prevention Deploying FLS Outside of Capitated Health Systems Capture the Fracture® Lessons Learned in the Implementation and Dissemination of the Model Addressing Another Treatment Gap in Osteoporosis Care: Racial and Gender Disparities Conclusion References 42: GRECC Connect: A VA Geriatric Telemedicine Consult Model of Care Challenge That Led to the Model of Care, the Patient Population Served, and Evidence for the Program Core Components of the Program Geriatric Clinical Consultations GRECC Connect Geriatrics-Focused Education Role of Interdisciplinary Health Professionals Lessons Learned in the Implementation and Dissemination of the Model Implications for Family Caregivers and Communities, Particularly Underserved and Diverse Communities How the Model Will Provide Care Across the Continuum, Particularly in the Context of Value-Based Payment Systems References Index