GRECC Connect Site - Madison, WI
Steve Barczi, MD: Geriatrician, professor of medicine, and clinician-educator who is board certified in geriatric medicine and sleep medicine and is the medical director of the GRECC Connect Clinic.
Ryan Bartkus, MD: Geriatrician at VA and UW Clinics, board certified in geriatric medicine. Involved in weekly interprofessional meetings in addition to leading Team CVT visits and educating trainees that rotate through the program.
Timothy Howell, MD: Geriatric Psychiatrist who provides pharmacological and non-pharmacological recommendations regarding mental health issues and educates the team on care models using the Wisconsin STAR Method.
Lindsay Clark, PhD: Advanced Geriatrics Fellow and licensed clinical psychologist who performs neuropsychological evaluations through CVT, interprets and presents the results to the interdisciplinary team and participates in the development of a treatment plan.
Lauren Welch, PharmD, BCGP: Clinical Geriatric Pharmacy Specialist who provides pharmaceutical recommendations focusing on medication optimization in older adults with use of potentially inappropriate medications, polypharmacy issues/de-prescribing and medication adherence.
Ellen Wanninger, MSW, CAPSW: Geriatric Social Worker who completes psychosocial assessments, gathers collateral information to supplement neuropsychological evaluation via CVT, assists patients and families with complex psychosocial issues, and provides resources for caregivers. Ms. Wanninger also updates the national and local GRECC Connect databases.
Stacie Monson, RN, BSN: Geriatric Nurse Care Manager who assists the team by providing nursing recommendations, communicating with outside providers and facilities, obtaining collateral information and requesting outside records.
Teresa Swader, MSW, LCSW: Geriatric Social Worker and UW-Madison School of Social Work field faculty instructor; provides recommendations regarding complex psychosocial assessments and interventions, along with education, training and supervision of GRECC social work staff and trainees.
The GRECC Connect Clinic encompasses an interprofessional team consisting of a geriatrician, geriatric psychiatrist, geriatric pharmacist, geriatric nurse care manager, geriatric social workers, and a geriatric neuropsychologist. The team receives consults from rural CBOC providers regarding complex, geriatric related cases. The majority of these patients live a great distance from geriatric services at VA hospital campuses, and have functional limitations that make traveling great distances a challenge. Providers can access the GRECC Connect Clinic through a menu of services including electronic consults (E-consults) for team-based chart reviews, clinical video teleconference visits (CVT) for neuropsychological testing and interdisciplinary team CVT visits with patients and their families/caregivers, and in some cases via a proactive panel co-management process. The GRECC Connect interprofessional team triages each consult to ensure that the service requested is most beneficial and appropriate for the provider and patient. Patient interactions often occur at designated rural CBOC sites that connect via telemedicine approaches with our Madison VA campus.
The GRECC Connect Interprofessional Team meets for two hours every week to triage new consults, complete team based E-consults, and review the electronic medical record in a unique follow-up process. The team discusses every consult to determine the appropriate clinic format to meet the provider or patient’s request. The team also uses the scheduled weekly meeting as a platform to complete team-based, interprofessional chart reviews (E-consults). This is a unique approach, as most specialty services have a single provider completing E-consults.
The team also uses the weekly team meetings to provide chart-based follow-up at three month and one year points from the initial GRECC Connect contact. The team reviews the electronic medical record to track how many recommendations were implemented, if the Veteran has utilized acute care, and if the Veteran has been relocated to a higher level of care. These brief reviews allow our team to communicate with the primary care teams at the rural clinics to reinforce initial recommendations or provide additional feedback.
The Wisconsin Star Method was developed by Geriatric Psychiatrist Dr. Timothy Howell. The GRECC Connect team uses the Wisconsin Star Method to organize information obtained from the electronic medical record to develop a holistic picture of the Veteran, while also identifying connections between specific factors and symptoms. The Wisconsin Star Method enables the interprofessional team to work together to develop comprehensive recommendations for the primary care team that addresses the complex health needs of older rural Veterans.
Panel Co-Management was implemented as a proactive approach to manage high-risk geriatric patients and improve timely recommendation follow through. With permission from consulting rural primary care providers, the team reviews providers’ panels one month in advance of upcoming appointments to identify medically complex patients who might benefit from an interprofessional approach. Criteria used in the case-finding strategy include:
- ≥ 10 medications
- Increased care utilization (ED, hospital and/or clinic visits)
- A diagnosis of dementia or cognitive impairment
- Recent functional difficulties or social issues
Once patients are identified meeting some of these criteria, they are added to the weekly team meeting to determine the appropriate level of intervention (E-consult, CVT, etc)
Clark LR, Wanninger E, King JS, Wenzel R, Welch L, Barczi, SR. Reducing disease burden in a telemedicine clinic using proactive outreach to at-risk rural Veterans. Oral presentation at: American Geriatric Society Annual Meeting; May, 2017; San Antonio, TX
Barczi SR. Telemedicine: Harvesting Technology to Improve Care. Oral presentation at the Pharmacotherapy in Older Adults with CVD U13 Conference sponsored by the American College of Cardiology, American Geriatric Society and National Institute of Health; February 2017; Washington D.C.
Barczi SR. GRECC Connect: Tele-dementia Innovations. GRECC Director’s National Virtual Meeting, Veterans Health Admin. Sept 2016.
Nicholas, C. Tele-neuropsychological Services for Rural Veterans. Poster presentation at: Geriatrics and Extended Care Leadership Conference; April 2016.
Nicholas C. Tele-Neuropsychology for Geriatric Rural Outreach. Symposium presentations at: Gerontological Society of America Annual Meeting; November, 2015; Orlando, FL.
Barczi SR. GRECC Connect- An Interprofessional Approach to Telemedicine. Symposium Presentation at: Gerontological Society of America Annual Meeting; November, 2014; Washington D.C.
Barczi SR. GRECC-Connect. Symposium Presentation at: Veteran Affairs Geriatric and Extended Care Leadership Conference. April 2014.
Barczi, SR. Triage and Tele-huddles Within GRECC Connect. Symposium Presentation at: Veteran Affairs Geriatric and Extended Care Leadership Conference. March 2013.
Barczi, SR. Geriatric Telemedicine in the VA. Oral presentation at Milwaukee VA Medical Center, Medical Grand Rounds, Sept 2016; Milwaukee WI.
Monson S, Wanninger E. GRECC Connect: Using Interprofessional Care to Bridge the Gap for Rural Veterans. Poster presentation at: University of Wisconsin- Madison Interprofessional Health Summit; April 2016; Madison, WI.
Langenburg D. Nicholas C, Welch L. Assessing Anticholinergic Burden and Medication Interventions Based on Tele-Neuropsychological Assessments in a Rural Geriatric Veteran Population. Oral presentation at: Regional Great Lakes Pharmacy Resident Conference; April 2016; West Lafayette, IN.
Welch L. GRECC Connect Clinic: Reaching Rural Geriatric Veterans. Poster Presentation at: Wisconsin Council on Medical Education Interdisciplinary Team Conference; November 2014; Wisconsin Dells, WI.
Vittetoe J, Welch L. Evaluation of the GRECC Connect Interdisciplinary Care Team on the Healthcare of Rural Geriatrics and Assessment of the Pharmacist’s Role within the Team. Oral presentation at: Regional Great Lakes Pharmacy Resident Conference; April 2014; West Lafayette, IN.
Welch L, Howell T. Alternative Approaches to Alzheimer’s Care: Tele-Geriatrics. Oral Presentation; November 2013.
Director’s Innovation Award Winner. William S. Middleton Memorial Veterans Hospital and Clinics; April 2015; Madison, WI.
Our GRECC Connect program receives generous support from the VA Office of Rural Health, and the VA Office of Geriatrics and Extended Care in close linkage with the national VA Geriatric Scholars Program. Infrastructure, space and personnel are provided through the support of our local VA hospital, the William S. Middleton Memorial Veterans Hospital, and the Madison VA Geriatric Research, Education, and Clinic Centers (GRECC). This GRECC collaboration allows our program to access unique expertise in dementia care, sleep medicine, geriatric prescribing/ de-prescribing and falls prevention/ management.
The Madison VA GRECC Connect program is also closely linked with the geriatric primary care team (Geri-PACT) at the Madison VA. Many of the GRECC Connect team members overlap with our core Geri-PACT members. Our team believes that a strong connection between GRECC Connect and Geri-PACT is a promising way to harness geriatric expertise and expand this type of geriatric telehealth programming to areas beyond the reach of the established catchment areas of our local VA hospital campus.