Longitudinal Rotation Components
To provide experience in continuity of care, the longitudinal components of the fellowship program involve care of two different groups of older persons over the course of the fellowship. The Phyllis and Lee Coffey Geriatrics Associates at the Martha Stewart Center for Living is the outpatient site where fellows see patients one or two half-days per week throughout the fellowship. This rotation prepares fellows to manage the many challenges in ambulatory geriatrics.
The Coffey Geriatrics Practice at the Martha Stewart Center for Living offers a comprehensive outpatient center for the care of community-dwelling older adults. Due to the multiple medical, psychosocial, and functional problems of many patients who attend the Practice, a team approach to care is practiced. A physician, nurse, nurse practitioner, and social worker work in concert to meet the many needs of our patients. The services of an on site Visiting Nurse Service/Home Care Agency as well as sub-specialty services are also vital components in helping us meet our patients’ needs. The Practice implemented an electronic medical record in 2006 to improve the information exchange and availability for our patients.
The Coffey Practice is divided into three care teams (formerly firms). Each care team is a smaller group practice consisting of attending physicians, nurse practitioners, first and second year fellows, medical assistants, front desk staff and social workers. Although each provider is responsible for the primary care of their own patient panel, all members of the team are expected to share in the care of each other's patients. An involved support staff enables the clinical team to function and includes a referral coordinator, practice manager, and billing/registration team.
To help ensure access to the care of medical sub-specialties, especially for those with limited function, the Practice has a cadre of sub-specialists who come to the Center, usually on a weekly basis, to see patients. Currently these include rheumatology, endocrinology, gastroenterology, and psychiatry.
The medical staff in the Practice serves a vital role in the education and training of not only geriatric fellows but also medical students, and nursing students. Due to the multiplicity of issues faced by our aging population, the Practice offers a fertile source for research for many of our trainees.
The Martha Stewart Center for Living serves to promote and facilitate access to health care resources for older adults and to enhance the public perception of aging. Through the Martha Stewart Center for Living, patients and their caregivers will have access to programs and resources appropriate for their needs and interests. These services may include medical care, healthy living activities, educational programs, patient and caregiver support.
We are a patient centered medical home. We strive for high quality team based care that is compassionate, coordinated, and accessible for older adults. We encourage self-management through group visits, patient/caregiver education and healthy living activities.
- To produce fellows who are skilled in caring for community dwelling older adults with multiple medical and psychosocial needs with the ultimate goal of improving the quality of care to patients.
- To train fellows to coordinate and implement recommendations from different specialties for their patients.
- The rotation at the Coffey Practice will prepare fellows to manage the many challenges in ambulatory geriatrics by assuring that they acquire a sound foundation in the principles of physiologic vs. pathologic aging. They will obtain clinical experience in recognizing and treating common medical problems and geriatric syndromes encountered in ambulatory care along with the practice of regular health maintenance. Fellows will gain experience with common assessment tools used to evaluate patients as well as an appreciation of the comprehensive team approach to the psychosocial and economic factors affecting the aging patient and the patient's family.
- We plan to enhance the clinical knowledge base and teaching skills through interdisciplinary conferences.
- We aim to instill the value of maintaining function and independence of patients through the development of appropriate goals based upon an individual patient’s prognosis and wishes, and to utilize technology to attain these goals in a cost-effective manner. We also aim to set specific learner objectives in the above areas as well as evaluate the fellow’s competency and proficiency in achieving these objectives.
General Guidelines for Fellows
The Coffey Practice is designed to provide a longitudinal, continuity of care experience in outpatient Geriatrics. Your rotation will consist of four major components:
- In the first component of your experience, you will assume the role of a primary care physician for a panel of patients whose care you will manage throughout your two years of fellowship training. As primary care provider, you will follow your patients in the Coffey Practice, be involved in their hospitalization, setup or direct any referrals for home care services and consultants, and respond to telephone communications from the patient or primary caregiver. The primary care provider should review all diagnostic test results and consultants’ reports. An assigned preceptor will supervise your patient sessions and assist with management decisions. You are also expected to function as part of a group practice and assist in the management of the Practice’s patients as directed by the preceptor.
- The second component will be attendance at your care team's scheduled meetings. These interdisciplinary meetings will be both administrative and educational. Their primary function is to enhance teamwork of the partnerships.
- The third component of this rotation will be for you to attend and participate in the ambulatory sessions during your rotation. You are expected to present a clinical question or challenging case at specified sessions. A preceptor will be available to assist with your preparation.
- The fourth component will consist of your supervising medical students, medical residents or nurse practitioners who are rotating in the Practice as part of their learning experience.
Home Visit Longitudinal Experience
All second year fellows will have a small panel of patients within the Visiting Doctors Program. At the end of the first year, each fellow will identify 2-4two to four patients among their Coffey practice who they feel would benefit from home visits. Throughout the second year, fellows will see their home care patients once a month. This day will occur during the monthly longitudinal week and fellows will see home care patients on the morning of their assigned clinic day (Mon/Tues/Fri). All fellows will have all the services and support of the Visiting Doctors staff. In addition, the first year fellow who is rotating in any given month will serve as first back-up if the primary fellow is unavailable.
Home Care Track
Second year fellows have the opportunity to choose the Home Care Track and spend three additional months at the Mount Sinai Visiting Doctors Program. This track was created in 2005 and can be tailored to suit the needs of each fellow. Fellows choosing this track will have a panel of 15 patients and will follow them as the primary physician with back-up from Dr. Linda DeCherrie, MD. This track will benefit any fellow who wants greater experience caring for the frailest elderly population. Each fellow in the track will gain a clearer understanding of how the current medical system works to care for this marginalized population – and will benefit any fellow in whichever venue they decide to practice: Home care, outpatient, inpatient or long-term care.
Jewish Home Lifecare Longitudinal Care
Each trainee will be assigned a panel of “long stay” patients; each will be followed through the year. If the resident is discharged or dies, a substitute will be provided. One day per rotation will be designated for continuity of care for these patients. This will involve the monthly assessment, examination, evaluation and note, and order changes and scheduling if required. When indicated, the trainee will contact family or proxy and any consultant or other professional involved in the resident’s care. The trainee will arrive at the nursing home by 9:00am, unless on Palliative Care, MACE or Consults. When a trainee will miss a continuity day, he will see the patients within one week before or after the due date.
Fellowship Academic Coordinator
Brookdale Department of Geriatrics and Palliative Medicine
One Gustave L. Levy Place
New York, NY 10029-6574