THINKING AHEAD: My Way, My Choice, My Plan

by Timothy L. Gieseke, MD, CMD

In 2008, the project I developed as a participant in the CALTCM LMG (Leadership and Management in Geriatrics) course was to implement the POLST in Sonoma County.  Fortunately, others in my county were on the same page. Susan Keller, a long time and persistent community advocate for improving palliative care wrote and submitted our first grant request for this project.  In the years since then, she has led innovative programs to support faith based palliative care and most recently has worked for improving THINKING AHEAD 2 for those with serious mental illness in collaboration with Sonoma County’s behavioral health division, the Coalition for Compassionate Care of California, and Goodwill Redwood Empire.  The final product is now available and worth your review.

CALTCM 2018 CME at the Bedside
by Timothy Gieseke MD, CMD

It's summer and I’m admitting more patients for rehab due to vacation coverage. Lately, many of my admissions have had an exacerbation of COPD. There are now many options for assessing the severity of COPD and for treating it. I’m grateful for our digital syllabus of this year’s annual meeting, which had the slides from Dr. Michelle Zeidler’s comprehensive evidenced based approach to this complicated subject. As she said in her talk, many of our patients with COPD receive substandard care for their condition and come to us with a plan that we can improve. With that in mind, I reviewed her presentation and now have some ideas on how I might better care for my recent admissions.  

At CALTCM, we want to partner with you in your efforts to improve the care you provide your patients. For this reason, we are making a PDF available of this excellent talk.  

Here’s to a cup of “Jo” and a time of cognitive stimulation.  
Click here to access Dr. Michelle Zeidler’s COPD presentation at the CALTCM 2018 Annual Meeting .
Is Reducing Serious Hypoglycemia one of your PIPs?

by Timothy Gieseke MD, CMD

This year, our state QIO, HSAG, has been sponsoring webinars that help our facilities reduce the risk for incurring a readmission payment penalty, when the financial penalties go live January 1, 2019.  I will be presenting the webinar on June 27th for reducing the risk of serious hypoglycemia. You can register at:

While there are many traditional things we can do to identify and manage this risk, our tool bag for safely lowering the risk has increased in recent years with the addition of SLG2’s and Incretin Receptor Agonists.  Both classes of medicines have a much lower risk of inducing serious hypoglycemia then oral sulfonylureas or insulin and both may help reduce weight and may reduce the risk of macro-vascular disease. Empagliflozin (Jardiance) and lirglutide (Victoza) now have an FDA indication for macrovascular risk reduction.  Empagliflozin is ineffective if EGFR is < 30, but liraglutide has no dose adjustment for renal or hepatic disease. The expense of both of these medicines is similar to the now high cost of our insulins.

What Consumers Say about Nursing Homes in Online Reviews
2018 Poster Session: 3rd Place Winner
Presented by: Yujun Zhu, M.S.G., [email protected]* - *Mr. Zhu is the team’s corresponding author. (See full list below.)
Background: Although patient-centered care is an expressed value of our healthcare system, no studies have examined what consumers say in online reviews about nursing homes (NHs). Insight into themes addressed in these reviews could inform improvement efforts that promote patient-centered NH care.

Methods: We analyzed NH Yelp reviews. From a list of all NHs in California, we drew a purposeful sample of 51 NHs, selecting facilities representing a range of geographical areas and occupancy rates. Two research teams analyzed the reviews using grounded theory to identify codes and tracked how frequently each code was mentioned.

Anticholinergic Burden Assessment and Future Diagnosis of Dementia

by Janice Hoffman Simen, PharmD, EdD, APP, BCGP, FASCP

Recently, an article published in the British Medical Journal, April 2018, looked at patients in the UK with a new dementia diagnosis and the use of prescription medications with anticholinergic adverse effects up to 20 years previously (Richardson, et al., 2018). In this study, the researchers found a link between a new dementia diagnosis and an increasing average Anticholinergic Burden score (ACB). According to the results of this study, the risk of dementia increases with an ACB greater than three, including exposure 15-20 years prior to diagnosis, with the following drug classes: antidepressants, urologic, and antiparkinson agents. The findings are interesting as a risk factor for the onset of dementia and encourages the assessment of anticholinergic burden in younger patients.

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