Geriatric Research Education and Clinical Center (GRECC)
Tennessee Valley GRECCThe Tennessee Valley GRECC has been serving older Veterans in Tennessee, Kentucky, and parts of West Virginia since 1999.
Disease Prevention: Prostate Cancer, Diabetes, and Colorectal Cancer
Therapeutics: Palliative Care, Renal, Gero-pharmacoepidemiology, cultural change in the long-term care setting and nutritional care and weight loss prevention in long-term care Veterans
Quality and Safety of Care: Prostate Cancer, falls assessment, improved geriatric care in rural CBOCs, hospital staffing, ICU post-discharge mortality, perioperative non-routine events and patient-aligned care teams
Critical Illness Associated Cognitive Impairment: delirium detection and monitoring and long-term assessment methods to define the relationship between delirium and long-term cognitive impairment controlling for covariates.
In 2016, GRECC faculty had 110 publications, contributing to each of its areas of focus. Examples include developing a national VHA inpatient risk stratification model for hospital-acquired kidney injury; demonstrating that depressive disorders predict incident acute myocardial infarction in HIV-infected adults; showing the risk of hypoglycemia following intensification of metformin treatment with insulin versus sulfonylurea; and demonstrating that surgery and anesthesia exposure is not a risk factor for cognitive impairment after major non-cardiac surgery and critical illness.
Education and Evaluation
GRECC faculty direct multiple educational programs and provide substantial education and training. In the past year, they have given over 250 educational presentations throughout the world with over 5,000 educational hours for VA clinicians or staff. GRECC faculty lead the OAA funded VA Quality Scholars Program, Palliative Scholars Program, Geri-Scholars Program, Biomedical Informatics Fellowship, Geriatrics Clinical Fellowship and Advanced Geriatrics Fellowship in addition to NIH funded training programs. We provide mentorship to 28 junior faculty with funded career development awards. We support 25 geriatric trainees in several disciplines, including nursing, pharmacy, psychology, social work, occupational therapy, audiology, speech pathology and pastoral care.
As new research findings are made available, the Associate Clinical Director, Associate Director for Education/Evaluation and GRECC faculty work closely to develop mechanisms to spread and incorporate these new clinical care innovations within TVHS and throughout the VISN. Our work in the diagnosis and treatment of critical care associated delirium and long term cognitive impairment has been spread throughout the world and is the focus of the U.S. national ICU Liberation project sponsored by the Society of Critical Care Medicine. The MICU-Palliative Care clinical demonstration project has impacted early upstream consultations and seamless transitions into the palliative care unit and discharge which have positively impacted Standard Mortality Rates. The peri-operative palliative care intervention has demonstrated improved advance care planning, decreased LOS and reduction of in-hospital mortality, with a 300% increase in palliative care consults between FY14-16. We developed and evaluated a general surgery telephone postoperative clinic at TVHS that decreased in-person clinic use from 0.83 visits per eligible patient pre-clinic to 0.40 after clinic with no difference in rates of emergency room visits or readmission.