2017 AMDA Conference

This session will highlight diagnostic challenges faced by providers when managing common infections (pneumonia, urinary tract infections and Clostridium difficile infections) in PA/LTC facilities, along with providing treatment updates. In addition, speakers will discuss strategies for prevention and early recognition of these infections. The audience will have the opportunity to seek answers for practical questions that they come across in their daily practice while managing common infections. This session will combine short presentations with interactive role-play session, small group case-based discussions, and an interactive panel discussion towards the end of the workshop.

Learning Objectives:
(1) Describe various clinical presentations of pneumonia, UTI and CDI in PA/LTC setting.
(2) Discuss the diagnostic challenges for pneumonia, UTI and CDI and the limitations of the available tests.
(3) Demonstrate practical steps that can be taken for prevention and early recognition of the common infections in the PA/LTC facilities.
(4) Review the treatment updates for pneumonia, UTI and CDI.

This interactive, case-based session will engage participants in problem solving commonly reported electrolyte abnormalities encountered in LTC. The cornerstones of understanding altered physiology, astute clinical assessment, and application of logical diagnostic and therapeutic strategies will be highlighted.

Learning Objectives:
(1) Interpret the BMP accurately, Diagnose and manage hyponatremia and hypernatremia.
(2) Identify causes work up and treatment of hyperkalemia and hypokalemia and acid base imbalance.
(3) Describe the differential diagnosis of hypercalcemia and hypocalcemia and appropriate management.

This session will discuss key factors leading to ineffective care transitions, emphasize the need for a new approach to delivering transitional care, and describe an integrated approach to achieve optimal transitional care. This approach is based on best practices of different models of care transitions and has not been implemented yet. It has seven key elements based on factors that can help achieve effective care transitions: (1) effective communication among providers; (2) discussion of goals of care and advance directives; (3) functional assessment; (4) medication reconciliation; (5) co-ordination and effective implementation of a care plan; (6) timely and quality discharge summaries; (7) patient-centered instructions and risk-related education.

Learning Objectives:
(1) Implement key elements of an effective care transitions into patient care.
(2) Establish strong communication and collaboration with community physicians, and hospital, and home care teams to provide optimal patient care during care transitions.
(3) Implement strategies for effective communication with patients, families and care teams during care transitions.

This session provides a review and update of legal issues of special importance to PA/LTC medicine providers participating in Medicare and Medicaid. The speakers will discuss key legal issues and concepts, and will guide the participants to develop and practice an approach to evaluating cases as part of ongoing quality assurance and compliance activities. This session will focus on the issues of medical necessity, false claims, and worthless care. The history and philosophy of these concepts and their application to PA/LTC settings will be discussed, along with illustrative cases, which participants will evaluate together.

Learning Objectives:
(1) Review the concepts of 'medical necessity', 'false claims', and 'worthless care', and their relationship to quality of care.
(2) Apply the concepts of “medical necessity”, “false claims”, and “worthless care”, and their relationship to quality of care to specific case examples to evaluate medical necessity and quality of care in individual cases.
(3) Describe the processes by which CMS and other government-related entities evaluate 'medical necessity', potentially 'false claims', and potentially 'worthless care' in PA/LTC settings, what SNFs and other providers do in response, and develop strategies for how PA/LTC practitioners and Medical Directors may be asked to participate productively in these processes to provide clinical insight and interpretation and help to resolve concerns.
(4) Discuss proactive strategies that will empower the physician/Medical Director to provide quality care to the patients at the SNF, assist the facility to be successful in the current increasingly challenging health care environment and assist the facility team to avoid – and successfully to refute if/when necessary – any unfounded allegation from any source of providing “worthless care” or of faling to meet the requirements of medical necessity.

This session will address the presentation of sepsis in older adults, early recognition of sepsis in PA/LTC residents and realistic expectations for managing sepsis based on the staff, training, and resources available in most PA/LTC settings.

Learning Objectives:
(1) Describe the clinical presentation of sepsis in older adult.
(2) Discuss initial assessment and management of an older adult with possible sepsis.
(3) Recognize the risks and benefits of attempting to manage sepsis in the PA/LTC setting.

By reviewing the quality improvement (QI) process, this session will offer the PA/LTC health care provider evidence-based and practical suggestions to implementing deprescribing, or more specifically a deprescribing initiative, into clinical practice. It will also review communication techniques for deprescribing utilizing case-based vignettes.

Learning Objectives:
(1) Review the role of deprescribing in management of polypharmacy or potentially inappropriate medications in PA/LTC residents.
(2) Explore and debate the elements of a successful PA/LTC deprescribing initiative within the QAPI format.
(3) Practice communication strategies for deprescribing with residents, family and caregivers, and other practitioners.

In this session, participants will learn a practical approach to addressing the concerns that arise for families and staff members when a person with a dementia diagnoses stops eating or develops dysphagia. The presentation emphasizes an approach that alleviates guilt and grief of the caretakers, makes sense of the natural process occurring and allows informed decision making on options of alternate nutrition.

Learning Objectives:
(1) Review the science of aging/dementia and anorexia.
(2) List the stepwise progression of anorexia that occurs in dementia diagnoses in a manner that makes sense.
(3) Use communication techniques that alleviates guilt of caregivers.
(4) Allow informed decision making in regards to potential alternate nutritional methods.

The session will present updates and outcomes from research about antimicrobial stewardship in PA/LTC settings, including cultural facilitators and barriers to improving antibiotic use and ongoing work that promotes antimicrobial stewardship as part of a culture of safety. Outcomes, challenges, and lessons learned shared in this session can support attendees seeking to innovate antimicrobial stewardship in their buildings.

Learning Objectives:
(1) Recognize features of community PA/LTCs settings that appear to correlate with lower rates of overall antibiotic use.
(2) Discuss outcomes from research that supported PA/LTC settings in using their own data and forming collaborative antimicrobial stewardship teams.
(3) Explain the relevance of implementing antibiotic stewardship as a part a culture of safety that includes leadership, administration and front-line staff.

This breakfast panel is an opportunity for attendees to engage leaders in medical direction in a dialogue on best practices. The focus of this panel is on geriatric clinical care and management from a clinical perspective.

Learning Objectives:
(1) Discuss the newest trends and developments in clinical care of the frail elderly.
(2) Implement recommendations for best practices in clinical medicine for the frail elderly.