Initiative Activities

Action Awards

Action Awards were one-year grants for up to $10,000 that were made available to interprofessional teams led by alumni of a John A. Hartford Foundation funded program for the purpose of achieving meaningful change to practice or policy that improves the health and wellbeing of older adults and/or their families.

Action Awards Overview

Read about the 34 Action Awards projects that have been funded by clicking the links below.

Spring 2014 Action Awardees

Fall 2014 Action Awardees

Spring 2015 Action Awardees

Fall 2015 Action Awardees

Policy Institute

The Hartford Change AGEnts Initiative Policy Institute provided an opportunity for Change AGEnts to gain new knowledge and acquire skills necessary to mobilize for action on policy issues to bring about improvements in health care and quality of life for older adults. Institute topics ranged from federal policy and regulatory change to state and local policy action. The Institute helped Change AGEnts gain a stronger understanding of the complex policy-making environment and the role that Change AGEnt involvement can play in driving policy outcomes. 

Click here to view the 2016 Policy Institute participants

Click here to view the 2015 Policy Institute participants

Click here to view the 2014 Policy Institute participants

Communications Institute

The Change AGEnts Communications Institute provided Change AGEnts with the communications knowledge and skills needed to help bring about improvements in health care and quality of life for older adults. The focus of the institute was communications in practice and policy change—topics covered ranged from messaging, elevator speeches, and value propositions to working with the media/social media and leading change in practice and policy arenas.

Click here for 2016 Communications Institute speakers

Click here for the list of 2016 Communications Institute participants

Click here for the list of 2015 Communications Institute participants

Click here to read about the 2015 Communications Institute speakers

Click here to view the list of 2014 Communications Institute participants

Patient-Centered Medical Homes

The vision of the Patient-Centered Medical Home (PCMH) Network was to transform PCMHs through recognizing, facilitating, encouraging, and ultimately improving the care of older adults and their caregivers. By advocating for and promoting the thoughtful insertion of geriatrics into the PCMH model, the PCMH Network sought to improve outcomes for older adults in the Comprehensive Primary Care (CPC) initiative and other PCMH sites.

The focus of the PCMH Network was to identify ways to improve the skills of PCMH clinicians who may not have had formal geriatric training at both the patient and population level. These efforts included evidence-based geriatrics education on specific topics, appropriate risk identification and stratification, and more geriatric-sensitive care management.

The PCMH Network was co-chaired by David Dorr, MD, MS, Associate Professor and Vice Chair, Medical Informatics and Clinical Epidemiology at Oregon Health & Science University in Portland, OR, and Rob Schreiber, MD, CMD, Medical Director of Evidence-based Programs at Hebrew SeniorLife and Medical Director of the Healthy Living Center of Excellence in Boston, MA.

Additionally, the Network enlisted seven geriatrics experts in the field of health care. The PCMH Network members were:

  • Christine (Himes) Fordyce, MD, Primary Care Physician, Group Health (Seattle, WA)
  • Robyn Golden, MA, LCSW, Director of Health and Aging, Rush University Medical Center (Chicago, IL)
  • Molly Mettler, MSW, Senior Vice President of Mission, Healthwise (Boise, ID)
  • Toni Miles, MD, PhD, Director, Institute of Gerontology, University of Georgia (Athens, GA)
  • Aanand Naik, MD, Associate Professor, Houston Center for Innovations in Quality, Effectiveness, and Safety at the Michael E. DeBakey VA Medical Center and Baylor College of Medicine (Houston, TX)
  • Harry S. Strothers III, MD, MMM, Chairman and Professor, Department of Family Medicine, Morehouse School of Medicine (Atlanta, GA)
  • Tasha Woodall, PharmD, CGP, CPP, Associate Director of Pharmacotherapy in Geriatrics, Mountain Area Health Education Center (Asheville, NC)

To read an overview about the Network click here.

To read the bios of the co-chairs and members click here.

To access the PCMH Paper: "Patient-Centered Medical Homes and the Care of Older Adults: How comprehensive care coordination, community connections, and person-directed care can make a difference" click here.

Dementia Caregiving Network

The Hartford Change AGEnts Initiative Dementia Caregiving Network (DCN) worked to achieve improvements in services, supports, and care for persons with dementia and their family caregivers. Initiated in January 2014, the DCN was composed of the following interdisciplinary group of nationally recognized leaders with expertise in practice, policy and research related to caregiving and dementia:

  • Co-chair: Alan Stevens, PhD, Baylor Scott & White Health
  • Co-chair: Nancy Wilson, MSW, Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Medical Center.
  • David Bass, PhD, Benjamin Rose Institute on Aging
  • Chris Callahan, MD, Indiana University
  • Debra Cherry, PhD, Alzheimer’s Greater Los Angeles
  • Amy Cotton, MSN, Eastern Maine Health Services
  • Gary Epstein-Lubow, MD, Brown University
  • Joseph Gaugler, PhD, University of Minnesota
  • Laura Gitlin, PhD, Johns Hopkins University
  • Lisa Gwyther, MSW, Duke University School of Medicine
  • Katie Maslow, MSW, The Gerontological Society of America

Taking Action

Highlights of DCN activities and information about work which continues to advance include:

Profiling evidence-based interventions that address the needs of family caregivers. Using interprofessional teams, the DCN developed and tested a carefully defined methodology for conducting comprehensive reviews of evidence-based programs for persons with dementia and their family caregivers. This work will help provider and payer organizations and other potential users understand the available evidence-based programs and care practices and make decisions about which ones to provide, pay for, and use. Separate grant funding was sought for creation of a “community-friendly” online decision support tool to make comprehensive information about programs’ research and implementation characteristics more broadly accessible, with program-comparison features, as well as feedback from current implementation sites. For more information, click here.

Developing a practical approach to identifying family members in the electronic health record who are providing care to older adults. This DCN project worked to define strategies and means of including reliable and culturally sensitive tools in the electronic health record (EHR) to assist in the identification of those providing care to family members. The goals of this work have been built around the following tenets:

  • Family caregiver information should be clearly visible to clinicians during all health care encounters.
  • Information reported by the family caregiver is clearly visible to clinicians during all health care encounters.
  • Schedulers and providers should be able to enter/edit information about the family caregiver.
  • Information should be put into a structured field that is reportable.

For more information, click here.

Improving dementia care and the identification, engagement, and support of family caregivers in the dually-eligible population. The DCN contributed to documenting, evaluating, and disseminating the promising practices of California’s Dementia Cal MediConnect program that strengthened the training and capacity of health plans to better coordinate dementia care with community agencies providing supportive services to family caregivers. The DCN mobilized necessary actors in other states and communities to adopt these promising practices in dementia care and family caregiver support. Texas and Rhode Island are including these practices and resources in their duals demonstration projects. With funding from the Administration for Community Living, Dementia Cal MediConnect has produced a toolkit with essential resources for health plans, community organizations, care managers, and family caregivers. For more information, click here.

Contributing to ongoing work on the development of performance/quality measures for dementia care that is person- and family-centered. DCN members submitted comments on national quality measures that resulted in substantive changes in work produced by the National Quality Forum. Commentary was also provided to the American Academy of Neurology/American Psychiatric Association for their proposed quality measures for dementia management, Dementia: Quality Measurement Set Update. DCN members also completed a policy commentary, “Improving Measurement of Dementia Care Quality to Advance Person-Centered Care,” for peer-reviewed publication (Gary Epstein-Lubow et al., 2016).

Fostering collaboration across national, state, and local organizations. To enhance the network of support services for dementia caregivers and influence practice change in all domains, DCN members nurtured collaborations. One or more DCN members provided leadership or participated in the activities described in the one-page summary. 

To read a one page summary of the work of the DCN, please click here.

Change AGEnts Action Communities

While the Change AGEnts Leadership Team believed in the value of in-person connections for networking and skill development, it also understood that distance and resource constraints necessitated the use of technology to communicate and organize for action. For this reason, the Change AGEnts Action Communities were developed as a collaborative, online network to learn from each other by sharing published and developing research, personal experiences, and contacts in the field using Change AGEnts Connect. To facilitate the transition to virtual work spaces, the Change AGEnts Initiative offered seed funding to the Action Communities to support off-line as well as on-line activities. Click here to read the Action Communities Overview.