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BACKGROUND

Mission

The 1998 Institute of Medicine report, “Retooling for an Aging America: Building the Health Care Workforce”, noted that older adults in rural areas are more likely to have higher rates of chronic illness, disability, and mortality than their urban counterparts. The goal of the VA Geriatric Scholars Program is to increase needed geriatrics team-based expertise in rural and highly rural community-based outpatient clinics (CBOCs) and VA Medical Centers by providing intensive education and training of primary care providers in the management of common geriatric conditions.

A well-established cornerstone of quality care for older adults is interdisciplinary teamwork. The RITT program will deliver a teambuilding curriculum for CBOC and VAMC staff, through interactive face-to-face and virtual training modalities.

Goals

The overarching goals of the workshop are to increase provider and staff knowledge and skills in geriatrics and to provide the tools for sustained team-based approaches for quality care for older Veterans. Topics include:

  • Identifying team-based solutions to care
  • Identification of geriatric red flags that require immediate attention when recognized
  • Discussion of common geriatric conditions including; sensory impairment, falls, dementia, delirium and depression
  • Overview and demonstration of cognitive screening tools

History

The Rural Interdisciplinary Team Training (RITT) Program was successfully piloted at five CBOCs across the United States between June and August 2011. Pilot sites included Rome, NY; Monterey, CA; Russellville, AR; Baraboo/Beaver Dam, WI; and Globe, AZ.  A total of 68 rural healthcare providers were trained during the pilot phase with an average of 11 providers participating in the training at each site. Providers who received the RITT included physicians, nurse practitioners (NPs), registered nurses (RNs), licensed practical nurses (LPNs), social workers, pharmacists, occupational therapists, program support assistants, and other professional and paraprofessional staff. 

All training participants were asked to complete a team self-assessment prior to the training, an end-of-day evaluation, a 30 day post-assessment survey, and a commitment to practice change.  Participants cited changes in their practice as a result of the RITT such as: monitoring/assessing for red flags and geriatric syndromes, enhancing active listening skills, screening for fall risks, and increasing sensitivity when communicating about culture and learning impairments.

key measures & impact

As of January 2022, the RITT workshop has trained over 2,200 participants from over 250 VA Medical Centers and CBOCs.

As part of the RITT evaluation, participants are asked if they are better able to recognize 9 "Red Flags" that identify when an older adult is at immediate risk (i.e., concern needs to be evaluated and addressed on day it is discovered) as compared to before the workshop.  These "Red Flags: include:

  • Recent hospitalization
  • Late for appointment
  • Walks slowly
  • "I don't know" or short answers
  • "We" haven't been doing so well
  • Falls
  • New medications
  • Confusion in hospital
  • Dizziness






92% of RITT trainees reported feeling "very confident" or "somewhat more confident" about communicating to a team member that an older Veteran is at immediate risk after participating in the workshop.



Current ritt trainers


Educator Clinician
  • Carmen Fernandez, MD 

  • Steven Barczi, MD
  • Eve Gottesman, BS  
  • Lana Brown, PhD
  • Jenice Guzman, PhD 
  • Thomas Caprio, MD 
  • Judith Howe, PhD 
  • Janette Dunlap, NP 
  • Josea Kramer, PhD
  • Helen Fernandez, MD


  • William Hung, MD 


  • Hillary Lum, MD


  • Ellen Olson, MD 
 
  • Michelle Rossi, MD
 
  • Emily Trittschuh, MD 
 
  • Nancy Weintraub, MD 


New for RITT 

  • RITT is expanding training opportunities to include a specialized curriculum for Home Based Primary Care (HBPC) Teams.  The HBPC RITT Training has both full day and half day trainings accredited for 6.5 and 3.75 hours of CEU/CME respectfully.

  • Due to the COVID-19 pandemic, RITT is now offering virtual training for 3.75 hours of CEU/CME.  For more information, click here.

  • GRECC Dementia Education Program (D.E.P.):  The goals of D.E.P. is towfold: to provide education to the VISN 2 workforce and to support caregivers of Veterans with dementia.  For more information, click here.

The RITT workshops are reinforced with follow-up webinars related to cognitive impairment and other topics presented during RITT.  Click here to view archived RITT webinars.
Last modified: Thursday, January 27, 2022, 4:55 PM