A grant awarded to a New York University College of Nursing professor for the development of a population health management program for aging adults incorporates care coordination as a central component.
Tara Cortes, PhD, RN, FAAN, professor of geriatric nursing and executive director of the Hartford Institute for Geriatric Nursing, was awarded a three-year, $2.55 million Health Resources and Services Administration grant through the Geriatrics Workforce Enhancement Program.
The grant will go toward building capacity of the primary care workforce in clinical and community settings in an effort to address healthcare gaps for older adults while maximizing patient and family engagement.
Dr. Cortes and her team will partner with Montefiore Health System and community organization Regional Aid for Interim Needs (RAIN) to implement a multi-modal educational intervention.
Dr. Cortes said:
“The education will focus on interprofessional geriatric-specific care, care coordination and the promotion of wellness through the Medicare annual wellness visit and managing chronic disease — specifically heart failure and diabetes. Community resources will support wellness behavior and chronic disease management.”
The project will be implemented in five of Montefiore Medical Group’s patient-centered medical homes, the Montefiore Einstein Center for the Aging Brain and many community sites in RAIN’s network.