Aging Q3 Falls ACOVE FacilitatorGuide

Facilitator’s Guide
Aging Q3
Medical University of South Carolina
Aging Q3 uses multiple strategies to teach residents about geriatric issues and syndromes. We
address 16 different issues and each issue is covered in a 3 month period. The goal is to cover all
16 topics in the Reynolds Foundation grant period of 4 years. Since we are aware that it is
difficult to reach all of the 100 internal medicine residents every 3 months using only one type of
intervention (such as lecture), multiple opportunities are provided. Each 3 month topic period is
called an “ACOVE” because the teaching content is based on the Assessing Care of Vulnerable
Elders (ACOVE) paradigm.1 Aging Q3 has expanded on the ACOVE paradigm to include
teaching residents about providing quality care for all adults 65 years of age and older.
Each ACOVE has a volunteer “work group” comprised of a chair person and 4-5 internal medicine
faculty members. The work group begins meeting 3-6 months before their ACOVE starts. They
develop the quality indicators, goals, objectives, key messages, interventions, and evaluation
plan for their ACOVE built on evidence-based best medicine practices identified through
literature review. The Aging Q 3 Principal Investigators, Evaluator, Data Analyst, and Project
Directors serve as work group consultants and program management personnel to assist the work
group in developing a successful and smooth program.
Aging Q3 highlights Soumerai and Avorn’s Academic Detailing model by using rapid and specific
teaching interventions with limited interruption in patient care. 1The clinical environment is
saturated with various visual cues such as posters, detailing sheets, and pocket cards in resident
populated areas such as conference rooms and precepting areas.
In the clinic, registration staff identify patients who are 65 years of age and over by placing a “blue
sheet” on the patient’s chart. When the Patient Care Technician sees a blue sheet on the patient
chart, she is reminded to ask the patient the ACOVE questions written on a “blue sheet.” The
“blue sheet” is attached to the patient’s chart and cues the resident to address the patient’s
responses to the questions and take noted action as necessary. Every 3 months the materials are
changed for each topic. A copy of the “blue sheet” for each ACOVE is included with the
ACOVE documents.

Included in this product are the principal tools developed and used in the Aging Q 3 program

ACOVEs to date. Additional tools will be added as new ACOVEs are developed. If there are


any questions about the details of Aging Q 3, content or process, please feel free to contact the
chair identified in the ACOVE product or the Aging Q 3 project director, Patty Iverson:


1 Soumerai, S. and J. Avorn. 1990: 263(4) “Principles of educational outreach (‘Academic Detailing’) to improve
clinical decision making.” JAMA 1990: 263(4). 549-556.
2 Annals of Internal Medicine. 2001;135(Suppl.):641-758 is devoted to the ACOVE indicators. Articles cover the
project overview, methods for developing the indicators, and the evidence supporting the quality indicators for 11 of
the topics.


II. Falls and Mobility
Educational Tools:
1.

Aging Q3 Falls Power Point Lecture
The lecture is given to the GIM Residents prior to the start of the ACOVE during
a regularly scheduled meeting time. The lecture is presented by the ACOVE
work group chair and the power point slides and audio are saved on the Aging
Q3 website: for future reference.
The lecture is also presented to the faculty and the nursing staff prior to the
ACOVE start date to familiarize them with the topic, key messages, teaching
interventions, and process.

2. Aging Q3 Blue Sheet
Clinic Registration staff identify patient is 65 years old or older. If they are, the
Blue Sheet is attached to their chart. When the Patient Care Technician takes

the patient in to the exam room, she notes the Blue Sheet on the chart and is
cued that this patient is 65 or over. Before the Resident comes in to see the
patient, the Patient Care Technician, asks the patient the questions on the Blue
Sheet and records the answers.
When the Resident comes into the patient exam room, he/she is cued by the Blue
Sheet to address the identified issues and take action as noted accordingly.
During precepting, the Resident will review the Blue Sheet answers and action
taken with the Attending during patient report.
This step is done for every patient 65 and over seen in the clinic by a Resident
during the ACOVE period (3 months).
3. Aging Q3 Detailing Sheet
During precepting, the Attending will review the key messages noted on the
Aging Q3 Detailing Sheet with the Resident. The Detailing message is
designed so this content can be covered in a very brief amount of time, usually
less than 5 minutes. The Attending documents that the Resident has been
detailed on the ACOVE topic.
4.

Aging Q3 Falls Skill Performance


During the Falls ACOVE, residents are asked to demonstrate the Timed Up and
Go (TUG) test on clinic patients 65 and over. The Resident follows the
algorithm for performing a fall history and a falls assessment as illustrated on
the detailing sheet, followed by a TUG test. The Resident uses the results of the
patient’s TUG performance to make clinical decision in the patient’s care and
treatment. Interventions as outlined on the detailing sheet algorithm are
considered if appropriate.
5. Aging Q3 Pre-test/Post-test
A short pre/post test (5-6 questions) is administered to the residents to evaluate

their knowledge and self-efficacy prior to the ACOVE intervention and after the
intervention has ended (3 months). The pre/post test is developed and
administered via “Survey Monkey” a web based survey development program
. The ACOVE working group creates questions
based on evidence based literature and the knowledge learning objectives
chosen by the work group for each ACOVE.
The pre test is sent to the resident’s email address 2 weeks prior to the scheduled
lecture date and ends prior to the beginning of the intervention. The post test
(same questions as pre test) is sent at the end of the intervention period. Results
are automatically tallied using the analysis feature in Survey Monkey. Further
analysis of the data is conducted by downloading the test results into excel or
other spreadsheet data base programs. In Aging Q3, the data analyst performs a
comparison of all the test takers performance using Generalized estimating
equation (GEE) models to test the differences on selecting correct answers on
the knowledge items and cumulative distributions to the report of action items
between pre and post tests. A comparison of matched resident’s performance is
also performed. McNemar’s tests are used to test the differences on selecting
the correct answers to the knowledge items, and Wilcoxon Signed-Rank Test is
used for the report of action items between pre and post tests.
A report is produced with the results of these analyses and feedback on the
resident’s improvement is presented to the faculty and residents. The pre/post
test results are used as information gathering only on the student’s knowledge
before and after the intervention.