Community Health and Mobility Partnership (CHAMP): Collaboration, Outcomes, and Expansion

BACKGROUND:

I first became interested in geriatrics during my acute care clinical rotation. I worked on the ortho/trauma unit of a large hospital, and interacted with many older adults who had chosen to receive hip or knee arthroplasties, or who had suffered hip fractures as a result of a fall. As I spoke with them, I appreciated the rich history of life experience that each one brought. I also learned about many of the challenges older adults face today, as they strive to maintain activities and relationships that are meaningful to them. While medicine often focuses on increasing length of life, I enjoy the opportunity as a physical therapist to make a direct impact on patients’ quality of life, to play an important role in helping patients return to their goals and passions. I have found working with older adults in both inpatient and outpatient environments, and through various volunteer activities, to be a very rewarding experience.

One program that advocates for health in the geriatric population is the Community Health and Mobility Partnership (CHAMP). It was created in order to identify older adults who are at risk for falls, and to provide an evidence-based exercise program that will help prevent future falls for these individuals. This program takes place once a month in several locations across North Carolina. Older adults are assessed for falls risk through questionnaires and physical performance tests. If appropriate, the patients are assigned exercises from the Otago Exercise Program, and are progressed as indicated at each following monthly session. I began volunteering with the CHAMP program in 2018, and I continued my involvement through this capstone project.

PROJECT OVERVIEW & PURPOSE:

Dr. Vicki Mercer, the founder of the CHAMP program, received an invitation to speak at the Mountain Area Health Education Center (MAHEC) regional conference on falls prevention, and to share about the CHAMP program with various professionals and community members. For my capstone, I prepared the presentation for this conference, with the goal of informing others about what CHAMP can offer to their area. The CHAMP leadership team is seeking to open a new location for the program in Buncumbe County, the same county that the conference was located in, so the interest of community members and professionals in this area is important in order to move forward with this plan.

STATEMENT OF NEED:

Falls prevention is a foundational element in geriatric care. Around 30% of older adults fall each year, and up to 42% of these falls result in injuries.¹ In fact, falls are the leading cause of fatal and nonfatal injuries in older adults.² A multifactorial risk assessment for falls is recommended by the American Geriatrics Association.² CHAMP meets this recommendation by providing screening in the areas of polypharmacy, orthostatic hypotension, footwear, vision, depression, and cognitive function, as well as strength and balance. In addition, CHAMP focuses on providing free care in rural areas where individuals may have limited access to medical resources. Approximately 20% of the population in Buncombe County are older adults, many of whom live in rural areas with limited medical resources.³ Therefore, this area would benefit from a monthly CHAMP program to reach this population. One of the first steps in starting CHAMP in a new location is gathering support from local community members and medical professionals, since CHAMP relies completely on volunteers to run the program. The MAHEC Conference, Spring into Falls Prevention, that occurred on April 10^th, was a gathering of many individuals with passion and experience in falls prevention in the geriatric population, and provided an excellent opportunity to inform others with a similar interest about how the CHAMP program works, and how older adults in the community can benefit from the program.

PRODUCTS:

The primary product that I created for my capstone were the PowerPoint materials for the MAHEC presentation. The title of the presentation was: CHAMP: Collaboration, Outcomes, and Expansion. The presentation materials included information about the basic structure of the CHAMP program, and how CHAMP can not only help prevent falls for older adults, but can also foster interprofessional collaboration and provide an opportunity for student volunteers to grow in clinical skills. Statistical information was also included in the presentation, demonstrating how participants improved in several falls risk indicators after three sessions of CHAMP. Finally, information about current CHAMP program locations, recent additions to the program, and plans for expansion into Buncombe County was included.

MAHEC April 2019 CHAMP Presentation

EVALUATION:

I communicated in an ongoing manner with my capstone advisor, Dr. Vicki Mercer, who provided valuable feedback for me as I prepared the presentation. I also received helpful feedback from my capstone committee members, Dr. Rosalyn Wasserman, and Dr. Lori Schrodt. An online evaluation of the conference and speakers is provided through MAHEC, and conference attendees are encouraged to complete this evaluation. I will be receiving information from this online evaluation at a later date.

SELF-ASSESSMENT:

I thoroughly enjoyed the learning opportunities that I was able to participate in through volunteering with the CHAMP program, and through preparing the presentation. I felt that my involvement gave me a unique inside perspective on how to create and maintain an effective community health program. I was able to see firsthand the importance of networking with other health professionals and organizations to achieve common goals. For example, at the McDowell County CHAMP Location, participants are often referred to the Matter of Balance program in the same area. The CHAMP program addresses strength and balance deficits for participants, while the Matter of Balance program addresses fear of falling. Many participants require intervention in both areas to improve their activity and prevent future falls. I also felt that I gained valuable experience in preparing learning materials for healthcare professionals. Peer to peer education is important in many healthcare settings, and I was able to grow in my ability to deliver information in a clear and informative manner.

ACKNOWLEDGMENTS:

I would like to thank my capstone advisor, Dr. Vicki Mercer, PT, PhD, for the support and insight that she provided throughout the project, and for beginning the CHAMP program in the first place. The program has impacted countless older adults. I would also like to thank my capstone committee members, Dr. Rosalynn Wasserman, PT, DPT, and Dr. Lori Schrodt, PT, MS, PhD, for their oversight of the project, and for the valuable feedback that they provided. Dr. Gabrielle Sconce, DPT, kindly assisted me by giving me access to CHAMP outcomes data, and by helping me prepare the data for viewing. I would like to thank my classmate, Alison Berglund, who was also involved with the CHAMP program, for the support and positivity she showed. Finally, I would like to thank all CHAMP volunteers for the time and energy they devote to making the program possible.

REFERENCES:

1. Health Quality Ontario. Prevention of falls and fall-related injuries in community-dwelling seniors: an evidence-based analysis. Ont. Health Technol. Assess. Ser. 2008;8(2):1-78.
2. Thompson K, Shi S, Kiraly C. Primary care for the older adult patient: common geriatric issues and syndromes. Obstet. Gynecol. Clin. North Am. 2016;43(2):367-379. doi:10.1016/j.ogc.2016.01.010.
3. United States Census Bureau. QuickFacts: Buncombe County, North Carolina. https://www.census.gov/quickfacts/buncombecountynorthcarolina. Accessed January 22, 2019.