Background: Healthy IDEAS (HI) an evidence-based, novel model of care implemented in 26 states, significantly improves depressive symptoms using non-clinical staff. HI is endorsed by the Centers for Disease Control and National Council on Aging. Methods The UNC Schools of Medicine and Nursing partnered with Baylor College of Medicine, and Care for Elders to convert the manual and skills-based instructional DVD into an interactive online course. Learners practice HI skills during an in-person class following the online course. Outcome measures included training time, cost, number of trainees and readiness to implement practice change measured by self-assessments. Results Fifty-four trainees from nine states enrolled during 2017. Training time decreased 33% and training costs by 50%. Ninety-eight percent rated the content, the self-assessments and the activities as meeting their needs. Forty-eight trainees rated their confidence to implement HI on a scale of 1–5. Average means: 4.73 I can empower clients to self-manage depression using behavioral activation. 4.69 I can use motivational interviewing to engage clients. 4.69 I understand how evidence-based programs are used in screening and intervention. 4.68 I can screen for symptoms of depression using valid tools. 4.66 I can adopt proactive approaches to depression education. 4.60 I can support clients in overcoming barriers/making progress. 4.53 I can effectively refer clients to treatment and link them to services. Conclusion This online course for non-clinicians to screen and intervene in depression among older adults was highly rated by 54 non-clinical staff. Online training strengthens the aging services workforce to sustain evidence-based programs.

Background The Otago Exercise Program (OEP) is an evidence-based falls prevention program that reduces falls by 35%. Methods The UNC School of Medicine, partnered with the CDC and the University of Wisconsin to disseminate OEP. Using online authoring software, instructional designers converted the manual into an interactive online course. Practice support webinars and a database of trained providers facilitated fidelity and patient access. Outcomes included number of trainees and readiness to implement measured by self-assessments. Results A total of 5,965 trainees representing 14 disciplines from 15 countries have enrolled. Of these, 48% (N=2,476) completed the evaluation. Ninety-eight percent (N=2,476) of the trainees agreed the course would improve their patients’ health; 97% (N=2,476) rated the content, the self-assessments and the activities as meeting their needs. The question “Based on knowledge gained in the activity, what will you do differently in your practice?” generated 1,633 comments: 29% will adopt the OEP and use it in home exercise programs 28% will use OEP screening and assessment tools 14% have more expertise in how to progress the exercises 10% will include more strength and balance exercises 5% will extend the course of physical therapy 5% will increase patient education and encouragement 2% will refer to community exercise programs Conclusion This online course to train healthcare providers to implement OEP was highly rated by 97% of the 2,476 trainees. Sixty-six percent of the respondents were able to give detailed examples of how they would change their clinical practice as a result of the online training.

Background Advanced Care Planning (ACP) is an ongoing process to ensure patient wishes for end-of-life care are respected. Medicare now reimburses primary care practices for ACP. Methods The UNC School of Medicine’s Division of Geriatric Medicine’s Geriatric Workforce Enhancement Program partnered with the South East Area Health Education’s Practice Support teams (SEAHEC) to increase ACP activities. ACP activities were measured in three ways:the number of conversations providers have with patients, the frequency of billing for ACP, and the completion of ACP documents. SEAHEC assessed electronic health records’ (EHR) capabilities, reviewed practice workflows, and designed and delivered educational materials. Materials included guides for practice managers and clinicians, monthly newsletters and video training. Seventeen practices with 37 providers participated. Data is reported on 14 practices. Results Following the intervention: Seven practices increased the number of ACP conversations from an average of 25% of patients to 55%. (Range 1% to 45% pre-intervention and 4% to 98% post intervention) Four practices increased the percentage of patients who have completed written Advanced Directives that are then scanned into the EHRs from an average of 8% to 12%. (Range 0% to 13% pre-intervention and 6% to 19% post intervention) Three practices improved their billing rate from an average of 1% of patients to 8%. (Range 0% to 13% pre-intervention and 4% to 98% post intervention) Conclusion Continuing education and quality improvement coaching supported by available reimbursement through Medicare can engage providers in improving rates of ACP conversations, billing and completion.

Background: The Carolina Geriatric Workforce Enhancement Program (CGWEP) integrated education and workflow modifications into four primary care practices in 2017 (Rural Federally Qualified Health Center, Family Medicine Clinics, and Internal Medicine Residency Program). Methods: The CGWEP partnered with practice support professionals in NC Area Health Education Centers (AHECs) to improve outcomes in falls, advanced care planning (ACP) and health literacy. Projects aligned with metrics included in the merit-based incentive payment systems and patient centered medical home criteria. Practices 1 and 2 focused on fall risk identification and reduction. Practice 1 emphasized clinic-wide education while Practice 2 reorganized workflows. Practice 3 chose to perform coaching of residents to facilitate ACP discussions. Practice 4 reorganized workflows and developed clinical competencies to improve efficiency. Results: Practices 1 and 2 - improvement in falls screening rates of 47% and 12% respectively. Intervention documentation improved by 93% and 17% respectively. Practice 3 - 3% improvement documentation of ACP education. Practice 4 -10% increase in practice productivity. Each practice experienced challenges with implementation of the PDSA plans. Through these projects the CGWEP team developed sixteen best practices to help address the challenges. Conclusions: Practice improvement resulted from innovative training of clinic staff, workflow redesign, and Plan, Do, Study, Act (PDSA) cycles. Enhancing geriatrics in primary care is most successful when projects are grounded in practice priorities aligned with existing quality metrics, provide whole team training, and develop efficiencies in practice workflow. PDSA evaluation cycles can identify new opportunities in workflow patterns and training.

Critical shortages in Geriatricians, especially in rural areas, require innovative training models. Building upon its strong partnerships across the state with various agencies, the University of North Carolina at Chapel Hill (UNC-CH) reaches rural communities through numerous methods. These include targeted webinars; statewide symposia on behavioral health and falls prevention; regional trainings; and quarterly coalition meetings that can be attended in person or via teleconferencing. Using these mixed methods to deliver education on geriatric topics provides the opportunity to reach rural audiences where they are and at convenient times for them. Evaluation metrics include participant evaluations; attendance at training events; satisfaction with educational products; and outside funding. Coalition longevity and attendance are also indicators of value. As a result of our combined efforts, statewide policy and funding in addressing geriatric issues have both been enhanced. Evaluation results of trainings indicate that attendees gained new ideas and strategies to address geriatric topics in their organizations and increased their understanding of evidence-based programs. The success of the coalitions has attracted additional grant funds to rural North Carolina such as the Administration on Community Living falls prevention grant to deliver evidence-based falls prevention programs. Additionally, funders such as the Kate B. Reynolds Charitable Trust have sponsored numerous behavioral health coalition and statewide program initiatives. Reaching rural areas that have limited resources requires a variety of distribution channels and strong partnerships. Educational trainings and products create concrete value that can then be leveraged into statewide action, which impacts policy and funding.

Wendolyn Gozansky1, Christina Clarke1, Deanna McQuillan1 and Jennifer Ellis1 1Kaiser Permanente Colorado

Ella E. Lyons, MS, Frederick Masoudi, MD, MSPH, Christina Clarke, BS, Christina Adams, MD, Pamela Peterson, MD and David Magid, MD, MPH Ella E. Lyons, MS, Institute for Health Research – Kaiser Permanente Colorado; Frederick Masoudi, MD, MSPH, Denver Health and University of Colorado at Denver and Health Sciences Center; Christina Clarke, BS, Institute for Health Research – Kaiser Permanente Colorado; Christina Adams, MD, University of Colorado at Denver and Health Sciences Center; Pamela Peterson, MD, Denver Health; David Magid, MD, MPH, Institute for Health Research – Kaiser Permanente Colorado and University of Colorado at Denver and Health Sciences Center