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South Texas Veterans Health Care System (STVHCS)

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GRECC Clinical Program

Sara Espinoza MD

The San Antonio Geriatric Research, Education and Clinical Center (GRECC) has a strong commitment to improving the care of older Veterans in South Texas. We work together with Geriatrics and Extended Care (G/EC) to conduct clinical demonstration projects (CDPs) and quality improvement projects, all aimed at developing better ways to care for older Veterans.

Sara E. Espinoza, MD, MSc, Associate Director for Clinical Programs, leads the GRECC clinical programs. Dr. Espinoza is a fellowship-trained, dual board-certified Internist and Geriatrician. She earned her medical degree in 2000 from the University of Virginia and completed her residency training at the University of Rochester Medical Center in 2003. She then completed a three-year clinical and research fellowship in geriatrics and gerontology at the Johns Hopkins Medical Institutions. Dr. Espinoza joined the San Antonio GRECC in 2006, and has since sustained an active research program investigating frailty. Dr. Espinoza is an active provider of clinical care as a G/EC geriatrician, both in outpatient and inpatient settings at the Audie L. Murphy Memorial VA Hospital. She is a funded clinical investigator whose research focuses on the epidemiology and pathophysiology of frailty. Dr. Espinoza is engaged in teaching through her clinical activities at the STVHCS, as well as in research education and mentorship of trainees at multiple levels in her role as Section Chief for Research with the Division of Geriatrics, Gerontology and Palliative Medicine in the Department of Medicine at The University of Texas Health Science Center at San Antonio (UTHSCSA) * .

Goals of GRECC Clinical Program

  1. Develop and disseminate innovative models of care for older adults, across a spectrum of social and physical functioning, from robust to frail.
  2. Conduct clinical and health services research, centered on G/EC clinical programs, to better understand and characterize the needs of our older Veteran patient population.
  3. Provide a robust clinical and research environment for clinical training and research education of trainees in geriatric medicine at multiple levels (students, residents, and fellows).

Current Clinical Demonstration Projects

  • GEM to GeriPACT Transformation (GeriPACT) - a project that emphasizes patient-driven, team-based health care delivery that is efficient, comprehensive, continuous and coordinated. The goal of the GeriPACT is to strengthen and expand existing staff and convert our Geriatric Evaluation and Management (GEM) clinic into the VA’s model for the patient-centered medical home, a Patient Aligned Care Team (PACT), and provide our older, complex primary care patients with better access to this newer more innovated model of care. Sara Espinoza, MD, MSc and Polly Noël, PhD lead this project.
  • Geriatric Medicine Education at Discharge (GMED) - a post-discharge interdisciplinary pharmacological intervention in high risk older Veterans following admission at the Audie L Murphy Division of the South Texas Veterans HealthCare System (STVHCS). Modeled after the very successful PILL program at the VA Boston Healthcare System, this enhanced medication education upon discharge includes follow up medication reconciliation and face-to face visits. Sara Espinoza, MD, MSc, a geriatrician leads this project.
  • Combined Geriatric Medicine and Palliative Care Consultation in the Medical Intensive Care Unit (MICU) – a quality-improvement and educational program which implements quality indicators for the care of older Veterans in the critical care setting. Older Veterans admitted to the ICU are at high risk of suffering due to lower resilience, the ICU environment, and invasive diagnostic and therapeutic interventions. The goal of this project is to perform a needs assessment of current systematic processes and practices relative to the care of older adult Veterans admitted to the MICU and to implement quality indicators for the care of older Veterans. The project is now focusing on decreasing risk of delirium among MICU older adults by increasing nursing staff assessment and awareness. Deborah Villarreal, MD, geriatrician and palliative care expert, leads this project.
  • Walking Clinic – in collaboration with the Little Rock GRECC this project targets elderly veterans who may have an inactive or sedentary lifestyle which has negative effects on physical and mental health, quality of life and healthcare cost. This service is a comprehensive approach to assess, educate, motivate, and encourage these veterans to commit to engage in regular walking. Through tailored counseling with the veterans and/or their family we believe this project will increase the number of elderly Veterans that engage and maintain a regular regiment of walking increasing their stamina and promoting health benefits. Dean Kellogg, MD leads this project.
  • Hearing Loss Impact Assessment – an evaluation of the impact of hearing loss on clinical care in the outpatient clinics at Audie L. Murphy Memorial VA Hospital. An educational video has been developed that dramatizes the effect of hearing loss on family and health care dynamics, and demonstrates the use of the Ling Six Sound Test to assess the presence of hearing loss in each patient. This video also demonstrates the effective use of Clear Speech and Pocket-style personal sound amplifiers to improve the experience of Veterans with hearing loss during their encounters with health care providers. GRECC faculty member and clinical audiologist, Robert Novak, PhD, leads this project.
  • Integrating an Advance Care Planning (I-ACP) – this project has developed a “floating” advance directives clinic, in which frail older Veterans with chronic medical conditions such as cancer, renal failure and cardiac disease are evaluated by the IACP team during a regular visit with their primary provider or specialist. During this shared medical appointment, high risk older Veterans and their family members are educated. A case-based video (produced in English and Spanish) provides education on advanced directive in order to encourage Veterans to make their own decisions. Sandra Sanchez-Reilly, MD, MSc leads this project.
  • Former Prisoner of War Clinic The VA Health Care System is mandated to provide priority treatment for Former Prisoners of War (FPOWs). Surprisingly, a significant number of FPOWs do not avail themselves of the benefits to which they are entitled. The goal of this project is to develop a new interdisciplinary team dedicated to increasing the involvement of FPOWs in the VA Health Care System. This project is led by Dr. Dean Kellogg.

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