![](media/image1.png){width="1.6194444444444445in"
height="0.2722222222222222in"}

+-----------------------------------------------------------------------+
| ### *GRECC Annual Report: Fiscal Year [2005]{.underline}*             |
|                                                                       |
| ######## Part II: Accomplishments                                     |
+-----------------------------------------------------------------------+
| This GRECC Annual Report covers [October 1, 2004-September 30,        |
| 2005]{.underline}: **the "Report Year"**.                             |
|                                                                       |
| This GRECC Annual Report reflects status and accomplishments of       |
| [**GRECC Core Staff \***only]{.underline}.                            |
+-----------------------------------------------------------------------+
| **\*[GRECC Core Staff ]{.underline}**is limited to either **Primary   |
| Core**, **Affiliate Core**, or **Research Core**:                     |
|                                                                       |
| -   **Primary Core =** positions authorized by the original GRECC     |
|     allocation plus any addition in ceiling from VA Central Office    |
|     specifically designated for GRECC.                                |
|                                                                       |
| -   **Affiliated Core** = Staff who work full- or part-time in        |
|     [direct support]{.underline} of the GRECC's research, education   |
|     or clinical activity.                                             |
|                                                                       |
|     -   May be either "contributed" by the VA Medical Center or       |
|                                                                       |
|     -   May have been acquired through centralized                    |
|         enhancements/awards for programs\                             |
|         (e.g., Home-Based Primary Care, Geriatric Evaluation and      |
|         Management Program, etc.)                                     |
|                                                                       |
|     -   To be considered Affiliated Core, staff must be               |
|         organizationally aligned under the GRECC or specifically      |
|         identified by the Medical Center as **"GRECC-affiliated       |
|         staff."**                                                     |
|                                                                       |
| -   **Research Core** = Full-or part-time staff who devote 51% or     |
|     more of their total time to GRECC research and whose salaries are |
|     supported by research funds (either VA or non-VA). Includes all   |
|     GRECC staff whose salaries are paid from research funds, e.g.:    |
|                                                                       |
|     -   Associate Investigator                                        |
|                                                                       |
|     -   Assistant Research Scientist                                  |
|                                                                       |
|     -   Senior Research Career Scientist                              |
|                                                                       |
|     -   Research Career Scientist                                     |
|                                                                       |
|     -   Advanced Research Career Scientist.                           |
+-----------------------------------------------------------------------+
| **1. GRECC NAME/LOCATION**                                            |
+-----------------------------------------------------------------------+
| a.  **GRECC Name:** Bronx/New York Harbor                             |
|                                                                       |
| b.  **Location** *(facility, VISN)*: Bronx, NY, VISN 3                |
+-----------------------------------------------------------------------+
| **2. CONTACT PERSON (if there are questions about this report)**      |
+-----------------------------------------------------------------------+
| a.  **Name:** Sarah Panepinto/Albert Siu, MD, MSPH                    |
|                                                                       |
| b.  **Position:** Administrative Official (Act.)/Director             |
|                                                                       |
| c.  **Phone, e-mail:** 718-584-9000 ext. 3803/                        |
|     sarah.panepinto@med.va.gov                                        |
+-----------------------------------------------------------------------+
| **3. GRECC FOCUS AREA(S)**                                            |
+-----------------------------------------------------------------------+
| GRECCs are required to conduct research in a basic biomedical area,   |
| an applied clinical area, and either a health services or             |
| rehabilitation topic. The number of specific research foci in each    |
| perspective should be limited to two or fewer.                        |
|                                                                       |
| Please enter a succinct phrase that best characterizes the focus      |
| area(s) recognized for your GRECC in the first two and either the     |
| third or fourth (or both) category below:                             |
|                                                                       |
| a.  **Basic Biomedical**: A research program focusing primarily on    |
|     proteomic and genomic research in geriatric palliative care. In   |
|     particular, the studies in Dr. Pasinetti's laboratory are         |
|     presently characterizing novel predicative biomarkers of          |
|     functional decline associated with frailty and pain among older   |
|     adults. The studies will provide a foundation for designing a     |
|     novel strategic plan aimed at improving quality of life and       |
|     independence in aging.                                            |
|                                                                       |
| b.  **Applied Clinical and Health Services**: Improving palliative    |
|     care for patients with advanced chronic illness and those near    |
|     the end of life. Prevention of functional disability from chronic |
|     diseases. Improving process and outcomes during transitions       |
|     between sites of care.                                            |
|                                                                       |
| c.  **Rehabilitation**: Not applicable                                |
+-----------------------------------------------------------------------+
| **4. ADMINISTRATION**                                                 |
+-----------------------------------------------------------------------+
| a.  **GRECC Impact on Host VAMC in Report Year**\                     |
|     *(list the most important ways in which the GRECC has had         |
|     positive impact on the host VAMc\--i.e., how the GRECC has "made  |
|     a difference" locally. **Please limit your response to five ways  |
|     or fewer.** Please be as succinct as possible but specify the     |
|     GRECC contribution, what the impact was and whom it benefited,    |
|     where it occurred, and why it was important. **Please limit the   |
|     description of each bullet item to 5 lines or fewer**)*           |
|                                                                       |
| -   Partha Deb, PhD was invited to the GRECC to give a seminar series |
|     (2-hour meetings) for VA and affiliated researchers on *Modeling  |
|     Health Care Costs.* 10-12 investigators attended each session.    |
|     This course summarized the large literature on the econometrics   |
|     of health costs, expenditures and utilization. The sessions       |
|     provided a "Users Guide" to modeling such data, including a tool  |
|     kit of methods for checking the quality of the fit of the         |
|     estimated model to the data.                                      |
|                                                                       |
| -   GRECC investigators presented research on Research Day and an     |
|     informational table was displayed highlighting GRECC activities.  |
|                                                                       |
| -   GRECC faculty are frequent grand round presenters at the Bronx    |
|     and New York Harbor VAMCs in addition to presentations made at    |
|     our academic affiliate. We also make available to Bronx VA and NY |
|     Harbor clinical staff the geriatric and palliative care grand     |
|     rounds presented at Mount Sinai (via video conferencing).         |
|                                                                       |
| -   GRECC faculty have increased the amount of VA HSR&D, NIH and      |
|     foundation funding for their research. Thereby increasing our     |
|     local VERA allocation.                                            |
+-----------------------------------------------------------------------+
| b.  **GRECC Impact on VISN in Report Year** *\                        |
|     (list the most important ways in which the GRECC has had positive |
|     impact on the host VISN\-- i.e., how the GRECC has "made a        |
|     difference" regionally. **Please limit your response to five ways |
|     or fewer.** Please be as succinct as possible but specify the     |
|     GRECC contribution, what the impact was and whom it benefited,    |
|     where it occurred, and why it was important. **Please limit the   |
|     description of each bullet item to 5 lines or fewer**)*           |
|                                                                       |
| -   GRECC faculty lead the nationally recognized VISN-3 palliative    |
|     care initiative. Dr. Carol Luhrs (3/8 GRECC) is the Director of   |
|     Palliative Care and leader of VISN initiatives. Drs. Evelyn       |
|     Granieri, Judy Howe and Joan Penrod all co-chair workgroups that  |
|     implements parts of the VISN initiative. GRECC staff coordinate   |
|     and provide administrative support for many of the VISN 3         |
|     palliative care activities. Additionally, as part of the          |
|     initiative, GRECC staff provided toolkits with palliative care    |
|     books and study guides to all the palliative care teams in the    |
|     VISN to encourage continuing education and certification of team  |
|     members.                                                          |
|                                                                       |
| -   The GRECC received a small grant from Amgen to develop and        |
|     disseminate a Patient Education Manual on Palliative Care, which  |
|     was distributed to all VISN sites in August 2005. This manual     |
|     based on a survey of patients and families with the VISN, is      |
|     being distributed to patients and families and is already being   |
|     replicated by other VISNs.                                        |
+-----------------------------------------------------------------------+
| c.  **GRECC Trend-Setting Innovations since October 1,                |
|     [2000]{.underline}**\                                             |
|     *(list the most significant research, education or clinical       |
|     innovations originating in your GRECC in the past five years.     |
|     Please limit your response to five innovations or fewer. For each |
|     item, succinctly describe the innovation, specify the time frame  |
|     of its earliest impact, whom it benefited, where it occurred, and |
|     why it was important. **Please limit the comments concerning each |
|     innovation to 5 lines or fewer**)*:                               |
|                                                                       |
| -   In March 2003, the GRECC convened a two-day workshop in           |
|     palliative care for all facilities in the VISN, with support from |
|     VISN leadership. The Kick-off Meeting, spawned by the VA AACT     |
|     program, resulted in a myriad of research, education, and         |
|     clinical initiatives within VISN 3, now widely recognized as the  |
|     leading such program in the nation.                               |
+-----------------------------------------------------------------------+
| **5. RESEARCH**                                                       |
+-----------------------------------------------------------------------+
| a.  **Most Noteworthy Findings Published in Report Year by GRECC Core |
|     Staff as PI or CO-PI\                                             |
|     ***(Please list five or fewer. For each noteworthy finding,       |
|     include the GRECC Core Staff name(s), journal reference, and a    |
|     JARGON-FREE description of the finding and its clinical or other  |
|     significance. Please limit your description of each noteworthy    |
|     finding to five lines or fewer.)*                                 |
|                                                                       |
| -   **Boockvar KS**, Litke A, **Penrod JD**, Halm EA, **Morrison      |
|     RS**, Silberzweig SB, ***Magaziner J***, Koval K, **Siu AL**.     |
|     Patient relocation in the 6 months after hip fracture: Risk       |
|     factors for fragmented care. J Am Geriatr Soc, 52: 1826-1831,     |
|     2004.                                                             |
|                                                                       |
| > This paper examines transitions in care locations of hip fracture   |
| > patients over 6-months post fracture. The study found that          |
| > relocation is common. Moreover, particular subgroups of patients    |
| > with elevated risk of relocation after hip fracture are good        |
| > candidates for intensive care coordination and care planning        |
| > interventions. It is also notable that the study is a result of     |
| > collaboration between researchers from two GRECCs, Baltimore GRECC  |
| > and the Bronx/New York Harbor GRECC.                                |
|                                                                       |
| -   Federman AC, Vladeck BC, **Siu AL**. Avoidance of Health Care     |
|     Services Because of Cost: Impact of the Medicare Savings Program. |
|     Heath Affairs, 24(1) 263-270, 2005.                               |
|                                                                       |
| > This article examined the potential for Qualified Medicare          |
| > Beneficiary (QMB) coverage to reduce the avoidance of health care   |
| > services because of cost among low-income seniors in eight states.  |
| > QMB enrollees were half as likely as non-enrollees to avoid         |
| > physician visits because of cost. Despite its potential to improve  |
| > access to primary care, the QMB program remains underused.          |
|                                                                       |
| -   McLaughlin M, Orosz GM~,~ ***Magaziner J***, Hannan EL, McGinn T, |
|     **Morrison RS**, **Hochman T**, Koval KJ, Gilbert M, **Siu AL**.  |
|     Preoperative status and risk of complications in patients with    |
|     hip fracture. J Gen Intern Med, 2005, in press.                   |
|                                                                       |
| > This paper reports on complications after hip fracture and          |
| > identifies the major risk factors for complications in these        |
| > patients.  The report has implications for risk stratification for  |
| > older patients undergoing urgent, rather than elective, surgery.    |
| > Most of the previous literature on risk factors for surgical        |
| > complications has focused on elective surgery. It is also notable   |
| > that the study is a result of collaboration between researchers     |
| > from two GRECCs, Baltimore GRECC and the Bronx/New York Harbor      |
| > GRECC.                                                              |
|                                                                       |
| -   **Siu AL**, **Penrod JD**, **Boockvar KS**, Koval KJ, Strauss E,  |
|     **Morrison RS**. Early ambulation after hip fracture: Effects on  |
|     function and mortality, Arch Intern Med, in press.                |
|                                                                       |
| This paper reports on the duration of immobility experienced by       |
| patients with hip fracture and its effects on                         |
|                                                                       |
| functional outcomes. It is one of the few papers that has examined    |
| the effect of bedrest on functional outcomes                          |
|                                                                       |
| in older patients.                                                    |
|                                                                       |
| -   Halm EA, **Siu AL**. Are quality improvement messages             |
|     registering? Health Serv Res, 40(2) 311-315, 2005.                |
|                                                                       |
| > This editorial comments on three articles in that issue of Health   |
| > Services Research that have negative or null findings on the QI     |
| > approaches tested. The authors coin the term "QI fatigue" to        |
| > describe a recent phenomenon whereby previously successful QI       |
| > strategies (such as decision support systems and clinical pathways) |
| > are no longer effective.                                            |
+-----------------------------------------------------------------------+
| b.  **Most Noteworthy Findings Published in Report Year -- GRECC Core |
|     Staff as Co-Investigators on Projects with Non-GRECC PI\          |
|     ***(Please list five or fewer. For each noteworthy finding,       |
|     include the GRECC Core Staff name(s), journal reference, and a    |
|     JARGON-FREE description of the finding and its clinical or other  |
|     significance. Please limit your description of each noteworthy    |
|     finding to five lines or fewer)*                                  |
|                                                                       |
| -   Nelson JE, Kinjo K, Meier DE, Ahmad K, **Morrison RS**. When      |
|     critical illness becomes chronic: informational needs of patients |
|     and families. J Crit Care, 20(1):79-89, 2005.                     |
|                                                                       |
| > Given poor outcomes for most chronically critically ill patients    |
| > and high costs and burdens of treatment, effective communication is |
| > essential when critical illness enters a chronic phase. The         |
| > findings provide a framework to clinicians for such communication   |
| > and a basis for further research.                                   |
|                                                                       |
| -   Resnick S, **Morrison RS**. Physicians' perceptions of procedural |
|     pain and discomfort. J Palliat Med, 7(5):646-651, 2004.           |
|                                                                       |
| > Physicians have an accurate perception of pain and discomfort       |
| > associated with common hospital procedures. Further investigation   |
| > should scrutinize in greater detail the ubiquity and depth of       |
| > physician knowledge about the issue of procedural burden and should |
| > focus on methods and interventions that would allow physicians to   |
| > consciously weigh the benefits and burdens of routine interventions |
| > in the care of persons with serious and life-threatening illness.   |
|                                                                       |
| -   **Boockvar KS**, Gruber-Baldini AL, Burton L, Zimmerman S, May C, |
|     ***Magaziner J***. J Am Geriatr Soc, 53:590-596.                  |
|                                                                       |
| > Using observational data and propensity score methods, outcomes     |
| > were worse in nursing home residents transferred to the hospital    |
| > within three days of infection onset than in those who remained in  |
| > the nursing home. It is also notable that the study is a result of  |
| > collaboration between researchers from two GRECCs, Baltimore GRECC  |
| > and the Bronx/New York Harbor GRECC.                                |
+-----------------------------------------------------------------------+
| **6. EDUCATION**                                                      |
+-----------------------------------------------------------------------+
| a.  **Innovations in Educational Activities Implemented During Report |
|     Year**\                                                           |
|     (*Please list up to five. For each, describe the innovation and   |
|     the context in which it was innovative. Please limit your         |
|     description of each innovation to five lines or fewer):*          |
|                                                                       |
| -   The GRECC, in partnership with Mount Sinai School of Medicine,    |
|     New York University, Columbia University, and Utica College, is   |
|     the recipient of a DHHS/BHP/HRSA Quentin Burdick Rural            |
|     Interdisciplinary Training Grant in Geriatrics Mental Health.     |
|     This highly competitive award has enabled the GRECC to            |
|     disseminate its curricular and content expertise to underserved   |
|     central New York State counties seeking to meet the growing need  |
|     for geriatrics expertise through training programs for faculty,   |
|     practitioners, and allied health students.                        |
|                                                                       |
| -   The GRECC impacts the agendas of national organizations in the    |
|     development, expansion, and dissemination of education and        |
|     training programs and products. For instance the GRECC AD/EE      |
|     chairs the national Association of Geriatrics Education Centers   |
|     and Association for Gerontology in Higher Education (AGHE)        |
|     Education Committees, and the AD/CC chairs the American           |
|     Geriatrics Society Education Committee. Through these             |
|     collaborations the GRECC has considerable influence nationally.   |
|                                                                       |
| -   Partnering with the Consortium of New York Geriatric Education    |
|     Centers (CNYGEC), the GRECC continues to expand its reach within  |
|     the VA. For instance, multi-site videoconferences occur five      |
|     times annually, and the June 2005 videoconference including 5     |
|     VISNs. This partnership has also resulted in CNYGEC providing     |
|     complimentary geriatrics training to VA employees.                |
|                                                                       |
| -   The GRECC has been a leader in providing interdisciplinary team   |
|     training in geriatrics and palliative care. GRECC leadership has  |
|     partnered with VISN 3 clinical staff to develop a variety of      |
|     workshops and manuals, and "went on the road" in the last year at |
|     national, regional, local and VA meetings, including the VA       |
|     National Leadership Conference in Pain Management, the Florida    |
|     Social Work Oncology Society, the Mount Sinai Geriatrics Board    |
|     Review Course, and the St. Albans Palliative Care Unit, to name a |
|     few venues.                                                       |
|                                                                       |
| -   The Education Division has been active in seeking funding         |
|     opportunities, both private and governmental, to enhance its      |
|     impact. It has been successful in several regards, including the  |
|     competitive renewal with partners of the Consortium of New York   |
|     Geriatric Education Centers which expands the GRECC's educational |
|     impact and enhances GRECC resources. The GRECC, through the       |
|     CNYGEC, has become known as a education and training magnet.      |
+-----------------------------------------------------------------------+
| b.  **Exportable Educational Products First Available for             |
|     Distribution in Report Year**\                                    |
|     *(Please list your most important products. Please limit to five. |
|     Your description of each item should succinctly summarize the     |
|     content, target audience, format, and product evaluation results  |
|     if any. You may include products developed in prior years ONLY IF |
|     THIS IS THE FIRST YEAR they have been available for distribution. |
|     Please limit each description to five lines or fewer)*:           |
|                                                                       |
| -   VISN 3 Patient Education Manual                                   |
|                                                                       |
| -   Interdisciplinary Curriculum on Geriatrics, Palliative Care, and  |
|     Interdisciplinary Teamwork, Volume 3                              |
+-----------------------------------------------------------------------+
| **7. CLINICAL INNOVATIONS**                                           |
+-----------------------------------------------------------------------+
| **NEW DEFINITION:** A "Clinical Innovation" is an untested,           |
| GRECC-initiated clinical effort that ideally is related to one of the |
| GRECC's research foci. A Clinical Innovation may be a wholly original |
| clinical program or an original aspect of or variation on an          |
| established program. A Clinical Innovation must incorporate an        |
| evaluation plan for assessing the innovation's efficacy so that, if   |
| the innovation is demonstrated to be an improvement over an existing  |
| approach to care, there is a basis on which it can be exported for    |
| implementation elsewhere.                                             |
+-----------------------------------------------------------------------+
| a.  **Clinical Innovations Underway in Report Year**\                 |
|     *(list all Clinical Innovations underway during the report year.  |
|     For each, indicate whether the innovation is [N]{.underline}ew or |
|     [O]{.underline}ngoing in the report year. Please describe each    |
|     innovation in five lines or fewer)*:                              |
|                                                                       |
| -   **Palliative Care Consults** ([O]{.underline}ngoing) -- inpatient |
|     and outpatient multidisciplinary consults for veterans with       |
|     life-limiting disease.                                            |
|                                                                       |
| -   **Supportive Care Unit** ([O]{.underline}ngoing) - 8-bed          |
|     palliative care unit within the nursing care unit care provided   |
|     by identified multidisciplinary staff.                            |
|                                                                       |
| -   **ICU-Palliative Care Collaboration** ([N]{.underline}ew) --      |
|     Palliative care team makes weekly rounds with ICU staff to        |
|     educate staff and identify patients for palliative care           |
|                                                                       |
| -   **Palliative Care Unit in Acute Care** ([N]{.underline}ew) -- 2   |
|     rooms in oncology unit renovated for imminently dying patients    |
|     and providing alternate venue of care for palliative care         |
|     patients dying in ICU                                             |
|                                                                       |
| -   **Outpatient Palliative Care Clinic** ([N]{.underline}ew) --      |
|     Interdisciplinary team treating patients before the imminently    |
|     dying phase while patients still reside in the community (2 sites |
|     within VISN)                                                      |
|                                                                       |
| -   **Geriatrics in Neurology** ([N]{.underline}ew) -- Geriatricians  |
|     see patients with progressive neurological disease with the       |
|     neurologist and physical therapist                                |
|                                                                       |
| -   **Geriatrics II Clinic** ([N]{.underline}ew) -- Teaching clinic   |
|     multidisciplinary, focusing on frail older adults                 |
+-----------------------------------------------------------------------+
| b.  **Evaluation Results of Clinical Innovations listed in the        |
|     preceding box\                                                    |
|     ***(for each clinical innovation listed in 7-a above, summarize   |
|     evaluation outcome(s) identified in the report year, in five      |
|     lines or fewer. Please specify "no evaluation results" for any    |
|     innovation for which that is the case)*                           |
|                                                                       |
| -   **Palliative Care Consults** **-** Consults increased from 182 to |
|     258 between FY 04 and 05, an increase of 42%. Additionally the    |
|     palliative care team consulted on or provided care to 61% of      |
|     patients who died at the Bronx VAMC in FY 05.                     |
|                                                                       |
| -   **Supportive Care Unit-** Supportive care unit admissions         |
|     increased from 48 in FY 04 to 54 in FY 05, average daily census   |
|     increased from 7.8 to 8.4 and LOS went from 55 to 48 days.        |
|                                                                       |
| -   **ICU-Palliative Care Collaboration-** This innovation began in   |
|     July 2005. To date, we have had 12 consults. We are conducting a  |
|     chart review to look at: 1) time between the identification of    |
|     poor prognosis and establishment of comfort care goals; 2) LOS in |
|     ICU; and , 3) Cost of care.                                       |
|                                                                       |
| -   **Palliative Care Unit in Acute Care -** no evaluation results    |
|                                                                       |
| -   **Outpatient Palliative Care Clinic-** 231 visits in Brooklyn in  |
|     FY 05, 96 in the Bronx. Evaluation is beginning in the following  |
|     areas: 1) reason for consult; 2 completion of advanced            |
|     directives; 3) patient/caregiver satisfaction; 4) emergency       |
|     department visits/hospitalizations; and, 5) Medication            |
|     management.                                                       |
|                                                                       |
| -   **Geriatrics in Neurology-** 50% geriatric syndromes; 25%         |
|     counseling; 25% care coordination                                 |
|                                                                       |
| -   **Geriatrics II Clinic --** no evaluation results since the       |
|     clinic began two weeks before the end of FY 05.                   |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| c.  **Clinical Innovation Exported in Report Year**\                  |
|     *(Please list up to five examples. In three lines or less for     |
|     each example, name or describe the innovation, identify the name  |
|     of the VA or non-VA facility to which it was exported, and the    |
|     method of export)*:                                               |
|                                                                       |
| -   Outpatient Palliative Care Clinic -- exported from Brooklyn to    |
|     the Bronx VA                                                      |
|                                                                       |
| -   Palliative Care Consults -- exported from the Bronx VA to all     |
|     VISN facilities through training and use of standardized          |
|     templates developed at the Bronx VA                               |
+-----------------------------------------------------------------------+
| **8. CONSULTATION AND OUTREACH**                                      |
+-----------------------------------------------------------------------+
| **DEFINITIONS:**                                                      |
|                                                                       |
| **"Consultation"** for this section of the report has occurred when   |
| GRECC staff has materially assisted in the development of a non-GRECC |
| research, education or clinical program **[within the host            |
| VAMC.]{.underline}**                                                  |
|                                                                       |
| **"Outreach"** for this section of the report has occurred when GRECC |
| staff has materially assisted in the development of a non-GRECC       |
| research, education or clinical program **[at a facility other than   |
| the host VAMC.]{.underline}**                                         |
+-----------------------------------------------------------------------+
| **Note:**                                                             |
|                                                                       |
| **for the 2005 Annual Report,**                                       |
|                                                                       |
| **Consultation and Outreach activity**                                |
|                                                                       |
| **will NOT be reported here.**                                        |
|                                                                       |
| **It will be reported via the Electronic Annual report Data Base.**   |
+-----------------------------------------------------------------------+