Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD
Founding Executive Director
Health Policy Institute
University of the Sciences in Philadelphia
Email: r.stefan@usip.edu

The greatest challenges facing our health care system is serving the needs of the growing senior population without bankrupting the federal government or other payers. This will require development of new systems of care that are patient-centered, preventative, integrated, and utilize an interdisciplinary approach.

WHAT IT ENCOMPASSES

Senior health involves improving the continuum of long term care (LTC) for seniors through integrating care for geriatric syndromes and use of alternative settings of care, expansion of managed care options, use of interdisciplinary care teams, and innovative information systems.

Given Dr. Stefanacci’s role as a practicing clinician, it also examines several specific geriatric syndromes for improved outcomes through policy design. The geriatric syndromes focused upon include: Alzheimer’s disease, polypharmacy, end of life care, gastrointestinal disorders, osteoporosis, and urinary incontinence.

WHAT IS ITS IMPORTANCE TO HEALTH POLICY

Efficient and effective systems of care are required given the growing number of aging Americans, the expansion of LTC demands, and limited resources. A key component of these systems of care is improved diagnosis and treatment of geriatric syndromes.

BRIEF HISTORY OF RESEARCH ON THIS SPECIAL TOPIC

Research on these topics has primarily focused on narrow silos of care, for example most pharmacoeconomic analysis has focused on single disease entity. This has limited real life application in geriatric healthcare because seniors typically have multiple diseases existing in complex systems of care.

CURRENT AREAS OF RESEARCH INTEREST

Opportunities exist through the utilization of large comprehensive data bases such as those generated by Medicare’s entry into the outpatient geriatric pharmaceutical market. This will allow researchers to examine complex relationships of disease states, varying treatment options as well as different systems of care to determine which can deliver optimum performance.

In addition, LTC innovative systems of care have been limited to demonstration programs under the Centers for Medicare & Medicaid Services (CMS) which limits their reach. The Medicare Modernization Act opens up these types of programs through the development of Special Needs Plans to encourage expansion of integrated systems of care.

FACULTY MEMBER’S SELECTED PUBLICATIONS RELATED TO THIS TOPIC

Text Books:

Stefanacci RG, Knight TC. (2005) Chapter: Pharmacist Involvement in Long-term Care for Seniors. Pharmacy & the US Health Care System – Third Edition; Finchan JE, Wertheimer AI.

Peer Reviewed Publications

Stefanacci RG (2005) Assisted Living Facilities: AGS Position Paper AGS HCSC, Journal of the American Geriatrics Society 53(3):536-37.

Stefanacci RG (2005) Assisted Living Facilities: Optimizing Outcomes, Journal of the American Geriatrics Society 53(3):538-540.

Stefanacci, R.G., Gilman, B.A., (2003) Case Study: Optimizing Medication Use in Skilled Nursing Facilities, Journal of Quality Health Care; 2(2):1-4

Stefanacci RG, Warden K, Lockett D. (2002) Case Study: Improving Clinical Resource Managed for a Group Practice.Journal of Quality Health Care. 1(4): 1-4.

Stefanacci RG, Clinger-DiGangi P, Leary D, Ishaq S.(2002) Using Computer-Based Learning to Get to Best Practices. Journal of Quality Health Care 1 (2):3-7.

Stefanacci RG (2002) Will Nurse Practitioners replace Physicians as attendings in LTC?Journal of the American Medical Directors Association, 2, 222-224.

http://download.journals.elsevierhealth.com/pdfs/journals/1525-8610/PIIS152586100470208X.pdf

Stefanacci RG (2001) The Delivery of Geriatric Health CareClinical Geriatrics, 9(6)13-14. http://www.mmhc.com/engine.pl?station=mmhc&template=cgfull.html&id=795

Position Statements Principle Author:

Managed Care Organizations (2003) AGS

http://www.americangeriatrics.org/products/positionpapers/AGS_MCO_final.shtml

Assisted Living Facilities (2004) AGS

http://www.americangeriatrics.org/products/positionpapers/ags_alf.shtml

Articles (non-peer reviewed journals):

Stefanacci RG (2005) Caring Where Seniors Live, USP Magazine, (in press)

Stefanacci RG (2005) Ethical Dilemmas – You’ve Got Mail, Caring for the Ages,(in press-May)

Stefanacci RG (2005) Ethical Dilemmas – Weight….Numbers Can Lie, Caring for the Ages,(in press-April)

Stefanacci RG (2005) Moving Beyond Commodity Pricing…..Pay-for-Performance, Jefferson University Health Policy Newsletter, (in press)

Stefanacci RG (2005) Ethical Dilemmas – Pay me now or later, Caring for the Ages,6(3):19.

Stefanacci RG (2005) Ethical Dilemmas – Driving Miss Daisy, Caring for the Ages, 6(2):11.

Stefanacci RG, Bolhack S. (2005) Networking the Assisted Living Facility with the Community, Assisted Living Consult, 1(1):14-18.

Stefanacci RG (2005) Assisted Living Consult: What’s in a name?, Assisted Living Consult, 1(1):6-7.

Stefanacci RG (2005) Ethical Dilemmas – Give me a shot, Caring for the Ages, 6(1):28.

Stefanacci RG (2004) Ethical Dilemmas – Extortion, Caring for the Ages, 5(12):25.

Stefanacci RG (2004) Ethical Dilemmas – My Wishes, Caring for the Ages, 5(11):20.

Stefanacci RG (2004) Ethical Dilemmas – More Hanging Chads, Caring for the Ages,5(10)10.

Stefanacci RG (2004) Ethical Dilemmas – Fire Control, Caring for the Ages,5(9) 9.

Stefanacci RG (2004) The Health Policy Debate Regarding Long-term Care Hospitals, Jefferson University Health Policy Newsletter, September 2004; 4.

Stefanacci RG (2004) Ethical Dilemmas – Just a Joke…..Right, Caring for the Ages,5(8):19.

Stefanacci RG (2004) Ethical Dilemmas – A Little Something Extra, Caring for the Ages,5(7):22.

Stefanacci RG (2004) Ethical Dilemmas – Disparities, Caring for the Ages,5(6):12.

Stefanacci RG (2004) Ethical Dilemmas – The Oath, Caring for the Ages,5(5):7.

Stefanacci RG (2004) Ethical Dilemmas – Do No Harm, Caring for the Ages, 5(4):11.

Stefanacci RG (2004) Hospital Quality Measures, Jefferson University Health Policy Newsletter, 17(1): 4.

http://www.jefferson.edu/dhp/HPN/HPN-03-04.pdf

Stefanacci RG (2004) Ethical Dilemmas – Unsafe Discharge, Caring for the Ages,5(3):25.

Stefanacci RG (2004) Ethical Dilemmas - Adversaries, Caring for the Ages,5(2):18-19.

Stefanacci RG (2004) Ethical Dilemmas – Disagreeable Payors, Caring for the Ages, 5(1):4-6.

Stefanacci RG (2003) The Interdisciplinary Team, Jefferson University Health Policy Newsletter, 16(3):8-9. http://www.tju.edu/ohp/HPN/HPN-09-03.pdf

Stefanacci RG (2003) CMS Health Policy Scholar Program, Jefferson University Health Policy Newsletter, 16(3):4. http://www.tju.edu/ohp/HPN/HPN-09-03.pdf

Stefanacci RG (2002) “Non-Chemical” Therapies Reduce ADRs, Caring for the Ages, 3(10):32-33. http://www.amda.com/caring/october2002/technology.htm[Utilized for the AMDA Curriculum on Geriatric Clinical Practice for LTC Faculty Training Kit]

Stefanacci RG (2002) Bring Your Team Together through Technology, Caring for the Ages, 3(60): 18 http://www.amda.com/caring/june2002/technology.htm

Stefanacci RG (2001) Reducing Medical Mistakes with Technology, Caring for the Ages, 3, 12. http://www.amda.com/caring/december2001/technology.htm

Stefanacci RG (2001) Technology in LTC: Getting a Jump Start at the Bedside, Caring for the Ages, 2, 20.

Stefanacci RG (2001) Time for Technology in LTC, Caring for the Ages, 8, 3-4. http://www.amda.com/caring/august2001/technology.htm

Stefanacci, R.G. (2001). Managed Care Principles that Work for LTC. Caring for the Ages, 2, 3 - 4.

Stefanacci, R.G. (2001). The EMR Solution. Physicians and Computers, 18, 36-27.

Stefanacci, R.G. (2000). Two Doctors Add Spice to Their Careers. The Medical Economics Audio Digit, 3.

Stefanacci, R.G. (2000). The Future of Electronic Records. Physicians and Computers, 18, 36 –37.

Stefanacci RG, Cafiero, A (2005) Antidementia Agents: Remembering What’s Important in this Class! P&T; Biotechnology; Managed Care (in press)

Beers MH, Stefanacci RG (2005) The Class Effect: Is It Relevant to Geriatric?, Journal of the American Geriatrics Society (in press)

Knight TC, Wertheimer AI, Stefanacci RG (2002) Identification of Potentially Inappropriate Medication Use in a Program of All-inclusive Care for the Elderly. The Consultant Pharmacist. 17: 1035-39.

Clinical Practice Guidelines:

GI Disorders in LTC (in production) American Medical Directors Association (AMDA) [ chair]

Dementia (in production) AMDA

Anticoagulation Management in LTC (in production) AMDA

LTC Physician Information Kit: Determination of Medical Necessity of Rehabilitation Therapy Services (2003) AMDA

Multidisciplinary Medication Management (M3) Tool Kit (2003) AMDA

Dehydration and Fluid Maintenance (2002) AMDA

Monograms Primary Author:

Envisioning the Future of Senior Care: New Models, Improved Outcomes (2004)

The Senior Care Source: Facts, Figures, & Forecasts (2005)

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