RIGHTCARE’S collaborative approach to research involves stakeholders throughout the research process, from establishing the research question, to developing data collection tools, to analysis and dissemination of findings. We use a research framework that aims to address the practical concerns of people in a community. The framework begins with a community’s issue, proposed action or strategy, and then supports or enhances this action with research that is community based and engaged. By its nature, our research is applied research; it seeks to change issues that are critical to communities and focuses on engaging community members in research directed at addressing their needs and concerns.
COMMUNITY BASED— grounded in the needs, issues, concerns, and strategies of communities and the community-based organizations that serve them. PARTICIPATORY—directly engaging communities and community knowledge in the research process and its outcomes. ACTION BASED AND ORIENTED—supporting and/or enhancing the strategic action that leads to community transformation and social change.
We are continuously engaged in research tied to achieving outcomes for seniors. Below are a sample of projects we are currently engaged in:
Nationally, there are millions of non-fatal falls requiring medical attention each year. These non-fatal falls account for hundreds of millions of dollars in emergency response alone and account for over 8 million DALYs (disability adjusted life years) lost. The largest morbidity occurs in people aged 65 yeas and older.
While large amounts of research has been done on falls over the last 20 years, its prevalence nationally, on senior campuses, and in local communities continues to rise year over year. A careful examination of the information surrounding falls reveals a repeating discussion of the same general contributing factors and limited options to deal with them. The unabated rate of falls within the existing senior population shows that no effective solutions or responses have been developed from understanding these large generic factors.
On the front lines dealing with the results of this epidemic is our dedicated EMS and Fire Department personnel. A review of the literature put out by fire department and EMS organizations shows discussion of the same problems faced across the country. Additionally, there are numerous secondary problems associated with responding to this epidemic of “lift assist” and “non-emergency” calls such as increased response times to overlapping calls and lack of funding for critical departments needs. No one has yet made a meaningful impact on the problem or changed the conversation locally. It appears that if this problem is going to be solved, it will have to be led by FD/EMS services. This project is a major step forward in solving this challenge.
In the search for understanding key levers to success, it is becoming clear that the current systems in place are not working. The general understanding of seniors who are at risk for “lift assist” and “non-emergency” calls has not generated effective solutions. Effective being defined as a sustained, cost effective, duplicatable programming that decrease the per capita number of lift assist and other preventable calls experienced within this population.
A senior person calling for a “lift assist” or other unsafe occurrence results from a specific and unique set of risks that caused them to have the unsafe occurrence leading to the call. In a majority of the cases, the senior’s pre-call scores have already over indexed in key areas to cause the crisis. If these key areas are not understood, measured, and improved, then it follows that another event necessitating emergency care or hospitalization will occur, whether or not there are additional risk factors resulting from the previous fall or crisis. Research has proven current solutions (social programs, home health, family involvement, clinician) when brought in to support change are unable to score these individual factors or effectively deal with them, resulting in continued risk of failure. Without clear understanding of these individual factors facing at risk senior populations, seniors are at risk of escalating frequency, types, and severity of unsafe occurrences.
Research suggests that the inadequacy of the demographic and medical record data on hand to provide a clear means to achieve outcomes and manage costs, fire departments, healthcare systems, and providers are hitting the ceiling of what they can do with current information sets. These poorly defined individual specific social-demographic-environmental-patient factors and behaviors appear to be where the majority of the causes for “non-emergency” and “falls and calls” and lie. So what are these factors causing such an enormous number of assists locally and nationally, and can they be defined and measured? If these individual factors could be identified, what would effective solutions look like that could adequately address them? What if it is this lack of awareness and understanding of specific factors, as well as a lack of effective follow up care that is setting up the next tragic event, ED visit, or hospitalization?
This goals of this collaborative are to: (1) quantify, for the first time in the country, the individualized (mSDOH) risk profile of the senior “fall assist,” and frequent caller, (2) quantify the deployment of necessary and effective resources for at risk seniors, (3) measure reduced follow up “lift assists,” and other preventable calls, (4) use education to promote awareness of the program to seniors and their adult children as evidenced by increasing the number of seniors/families who seek collaboration proactively, (5) measure the subjective experience of the seniors and family.
Thirty home health locations will triage the risk profile of patients from the 144 risks found on the SAFEST assessment. Treatment plans will be developed and executed with initial emphasis on the high risk/high frequency risks and sub-category of medical condition management risk across seven key areas. Monthly in-person, collaborative case-conference meetings will be held to review titration of remaining risks and strategize for score improvement. Impact on reduction of frequency, severity, and type of unsafe occurrence will be quantified as well as on hospital admissions.
31 locations, 15 states, N=55,000
For this project a PBHS mSDOH model, LIFE Profile, (Lifestyle Feasibility Profile), is being used for client assessment and care plan development. The assessment delivers new data sets for care planning to maximize the value and benefit of in-home services. Scoring and outputs collected from the LIFE Profile assessment will deliver a care plan which is comprehensive, individualized, goal driven, and define individual and shared responsibilities for all participants that are involved in achieving care outcomes.
Scope 196 locations, 42 states, expected N=23,000.
This project is designed to formalize advanced senior ministry programming aligned with RIGHTCARE objectives in a mega church setting (10,000+). The goal is to adapt and finalize coordinated planning, management, and execution of related campus projects directed toward the same organizational objectives achieved in smaller churches.
If you or your organization are interested in being involved or knowing more about opportunities with community based research in your local community please contact us here:
RIGHTCARE Senior Board Member
Kurt Merkelz, M.D., is senior vice president and chief medical officer of Compassus and has been in this role since 2017.
Throughout his career, Merkelz has focused on caring for older adults. His perseverance in raising industry benchmarks for quality hospice care earned him the Compassus R. Sean Morrison, M.D., Award for Outstanding Achievement in Hospice Physician Leadership. He is currently serving a third term as co-chair for the National Quality Forum (NQF)’s Measure Applications Partnership (MAP) post-acute workgroup. Dr. Merkelz pioneering work in standardized care delivery garnered Compassus national recognition by NQF in 2020. Merkelz serves on several national organization committees including AAHPM, AMDA, and NHPCO.
Merkelz is triple-board certified in hospice and palliative care medicine, family practice and geriatrics.
President, Performance Based Healthcare Solutions,
RIGHTCARE Board Member, RC Projects Leader
Randy is the head of research for PBHS (Performance Based Healthcare Solutions) which he founded in 1999.
Over the course of the last twenty two years Randy has led applied research collaboratives with 300+ care organizations involving over 75,000 senior lives. The research has been focused on categorizing, quantifying, and achieving the outcomes seniors need to achieve in order to be successful. His direct work has led to standardized care and care delivery models used in over 39 states in the U.S. as well as Canada and Australia. You will find him either leading integration projects, performing care visits for his local churches, or with his wonderful family playing along the Texas Gulf Coast where they live.