Katherine T. Ward, MD

All Publications

• Informing Dementia Support Programs That Serve Low-Income, Multilingual Communities in a Safety Net Health System: Use of Focus Groups to Identify Specific Needs. Geriatrics (Basel, Switzerland) Pak, A., Demanes, A., Wu, S., Ward, K., Hess, M. 2024; 9 (2)

  Abstract

  The Centers of Medicare and Medicaid Services recently announced a new voluntary nationwide model. This model aims to provide comprehensive, standard care for people living with dementia and their unpaid caregivers and to enhance health equity in dementia care. However, little is known about the needs of older adults with dementia and their caregivers in a multiethnic and multicultural patient population of a safety net health system. The aim of this study is to include their voices. We conducted four focus groups in English and Spanish to investigate the common needs and barriers unique to the care of patients within the Los Angeles County healthcare system. Using qualitative, iterative analyses of the transcripts, we identified four domains of concern from the dyads (persons with dementia and their caregivers): need for education for dyad-centered care, barriers to resources, dyad safety, and caregiver burden and insight. These domains are interconnected, and the way this patient population experiences these domains may differ compared to those in well-resourced or predominantly English-speaking healthcare settings. Therefore, the identified domains serve as potential building blocks for dementia support programs inclusive of underserved, multicultural populations.

  View details for DOI 10.3390/geriatrics9020033

  View details for PubMedID 38525750

• Geriatric Assessment Comprehensive geriatric assessment Ward, K. T., Reuben, D. B. UpToDate. 2022
• Systematic Review of Dementia Support Programs with Multicultural and Multilingual Populations. Geriatrics (Basel, Switzerland) Demanes, A., Ward, K. T., Wang, A. T., Hess, M. 2021; 7 (1)

  Abstract

  Dementia care programs have become more common due to a growing number of persons living with dementia and lack of substantial benefit from pharmacologic therapies. Cultural and language differences may present barriers to access and efficacy of these programs. In this article, we aimed to systematically review the current literature regarding outcomes of dementia care programs that included multicultural and non-English speaking populations.A systematic review was conducted using four scientific search engines. All studies included in the review are English language, randomized control trials evaluating various care coordination models. The initial search strategy focusing on studies specifically targeting multicultural and non-English speaking populations resulted in too few articles. We expanded our search to articles that included these populations although these populations may not have been the focus of the study.Seven articles met inclusion criteria for final review. Measured outcomes included emergency room use, hospitalizations, provider visits, quality of life indicators, depression scores, and caregiver burden.Dementia care programs demonstrate significant ability to provide support and improve outcomes for those living with dementia and their caregivers. There is limited research in this field and thus opportunity for further study in underserved and safety net populations including more high-quality randomized controlled trials with larger sample sizes.

  View details for DOI 10.3390/geriatrics7010008

  View details for PubMedID 35076511

  View details for PubMedCentralID PMC8788268

• Staffing in California Public Hospital Palliative Care Clinics: A Report from the California Health Care Foundation Palliative Care in Public Hospitals Learning Community. Journal of palliative medicine Rabow, M. W., Parrish, M., Kinderman, A., Freedman, J., Harris, H., Cox, D., Liao, S., Yu, K., Ward, K., Landau, C., Kerr, K. 2021; 24 (7): 1045-1050

  Abstract

  Background: Although clinic-based palliative care (PC) services have spread in the United States, little is known about how they function, and no studies have examined clinics that predominantly serve safety net populations. Objectives: To describe the PC clinics operating in safety net institutions in California. Design: Survey completed by PC program leaders Setting/Subjects: PC programs in California, USA, safety net medical centers. Measurements: Descriptive statistics regarding staffing, clinic processes, patients served, and finances. Results: Twelve of 15 programs responded; 10 clinics that met inclusion criteria. All 10 programs use multiple disciplines to deliver care. Average full-time equivalent (FTE) used to staff an average of 2.75 half-day clinics per week includes 0.69 physician FTE, 0.51 nurse practitioner FTE, 1.37 nurse FTE, 0.79 social worker FTE, and 0.52 chaplain FTE. Clinic session schedules include an average of 1.88 new patient appointment slots (standard deviation [SD] = 0.44) and four follow-up appointment slots (SD = 1.95). The nine programs that reported on clinic volumes see 1081 patients annually combined, with an annual average of 120 (SD = 48.53) per program. Encounters per patient averaged 3.04 (SD = 1.59; eight programs reporting). All reported offering seven core PC services: pain/symptom management, comprehensive assessment, care coordination, advance care planning, PC plan of care, emotional support, and social service referrals. An average of 77.4% (SD = 26.81) of clinic financing came from the health systems. Conclusions: Our respondents report using an interdisciplinary team approach to deliver guideline-concordant specialty PC. More research is needed to understand the most effective and efficient staffing models for meeting the PC needs of the safety net population.

  View details for DOI 10.1089/jpm.2020.0562

  View details for PubMedID 33400906

• Teaching Geriatrics and Transitions of Care to Internal Medicine Resident Physicians. Geriatrics (Basel, Switzerland) Wu, S., Jackson, N., Larson, S., Ward, K. T. 2020; 5 (4)

  Abstract

  (1) Background: Internal medicine (IM) resident physicians need to be trained to care for older adults and transition them safely across care settings. Objective: The study purpose was to evaluate the efficacy of a curriculum in geriatrics assessment and communication skills for transitions of care (TOCs) to IM resident physicians. (2) Methods: IM residents rotated for 4 weeks on the geriatrics consult service at a large public teaching hospital, where they received didactic lectures and clinical experience in consultation and transitional care. The curriculum was designed to meet consensus guidelines for minimum geriatrics competencies expected of IM residents. Previously validated and published assessment tools were used for geriatrics knowledge and attitudes. Locally developed tools were used to directly observe and rate communication skills, and self-assess geriatrics assessment and health literacy skills. The curriculum was evaluated using a quasi-experimental, nonrandomized, single-group pre- and post-test observational design. Data on 31 subjects were collected over 18 months and analyzed using mixed-effects models. (3) Results: Average knowledge scores improved from 65% to 74% (Δ9%, 95% CI 4-13%, p < 0.001). Communication skills improved by an average of 1.15 points (95% CI 0.66-1.64, p < 0.001) on a 9-point scale. Attitudes did not change significantly. Self-rated confidence in geriatrics assessment and health literacy skills improved modestly. (4) Conclusions: The curriculum is effective in teaching basic geriatrics knowledge and communication skills, and increasing self-confidence in geriatrics assessment skills. In settings where an inpatient geriatrics consult service is feasible, the curriculum may be a model for combining geriatrics and TOC training.

  View details for DOI 10.3390/geriatrics5040072

  View details for PubMedID 33050060

  View details for PubMedCentralID PMC7720122

• Exploring system, site, and patient level factors affecting implementation of a dementia care support program in a safety net health system Hedmann, M. G., Andrade, E. A., Schickedanz, H. B., Ward, K., SEGAL-GIDAN, F., Hess, M. WILEY. 2020: S241

  View details for Web of Science ID 000792068400691

• Methods for overcoming barriers in palliative care for ethnic/racial minorities: a systematic review. Palliative & supportive care Mayeda, D. P., Ward, K. T. 2019; 17 (6): 697-706

  Abstract

  Ethnic/racial minority groups are less likely to discuss issues involving end-of-life treatment preferences and utilize palliative care or hospice services. Some barriers may be differences in language, religion, lower levels of health literacy, or less access to healthcare services and information. The purpose of this article is to conduct a systematic review on interventional studies that investigated methods to overcome the barriers faced by ethnic/racial minorities when accessing end-of-life services, including completing advanced directives, accepting palliative care, and enrolling in hospice.Literature searches using four standard scientific search engines were conducted to retrieve articles detailing original research in an interventional trial design. All studies were conducted in an outpatient setting, including primary care visits, home visits, and dialysis centers. Target populations were those identified from ethnic or racial minorities.Nine articles were selected to be included in the final review. All were full-text English language articles, with target populations including African Americans, Hispanic or Latinos, and Asian or Pacific Islanders. Measured outcomes involved level of comfort in discussing and knowledge of palliative care services, desire for aggressive care at the end-of-life, completion of advance directives, and rate of enrollment in hospice.Three main avenues of interventions included methods to enhance patient education, increase access to healthcare, or improve communication to establish better rapport with target population. Studies indicate that traditional delivery of healthcare services may be insufficient to recruit patients from ethnic/racial minorities, and outcomes can be improved by implementing tailored interventions to overcome barriers.

  View details for DOI 10.1017/S1478951519000403

  View details for PubMedID 31347483

• Geriatric Assessment in Multicultural Immigrant Populations. Geriatrics (Basel, Switzerland) Ward, K. T., Hess, M., Wu, S. 2019; 4 (3)

  Abstract

  While the traditional comprehensive geriatric assessment provides valuable information essential to caring for older adults, it often falls short in multicultural immigrant populations. The number of foreign-born older adults is growing, and in some regions of the United States of America (U.S.), they encompass a significant portion of the older adult population. To ensure we are caring for this culturally diverse population adequately, we need to develop a more culturally competent comprehensive geriatric assessment. In this review, we explore ways in which to do this, address areas unique to multicultural immigrant populations, and identify limitations of the current assessment tools when applied to these populations. In order to be more culturally sensitive, we should incorporate the concepts of ethnogeriatrics into a comprehensive geriatric assessment, by addressing topics like healthcare disparities, language barriers, health literacy, acculturation level, and culturally defined beliefs. Additionally, we must be sensitive to the limitations of our current assessment tools and consider how we can expand our assessment toolkit to address these limitations. We discuss the limitations in cognitive screening tests, delirium assessments, functional and mental health assessments, advance care planning, and elder abuse.

  View details for DOI 10.3390/geriatrics4030040

  View details for PubMedID 31247952

  View details for PubMedCentralID PMC6787672

• A New Curriculum in Geriatrics and Transitions of Care for Vulnerable Elderly for Internal Medicine Residents Wu, S., Ward, K. T., Jackson, N., Lee, M. WILEY-BLACKWELL. 2016: S48

  View details for Web of Science ID 000374763800133

• THE USE OF EVIDENCE-BASED PROGRAMS FOR OLDER ADULTS IN UNDER-RESOURCED COMMUNITIES IN LOS ANGELES COUNTY Brown, A. F., Seeman, T., Ward, K., Kuo, T., Ramirez, K., Lynn Phan Vo, Vassar, S. D., Sankare, I., Martinez, A., Pritzker, S. SPRINGER. 2016: S435-S436

  View details for Web of Science ID 000392201601256

• When Physician Family Members Are Involved in Patients' Care. American family physician Chandra, A., Bharadwaj, P., Ward, K. T. 2016; 93 (5): 388-91

  View details for PubMedID 26926976

• alliative Care for Dementia Patients: Practical Tips for Home Based Programs Bharadwaj, P., Chandra, A., Fitzgerald, G., Ward, K. National Hospice and Palliative Care Organization. 2016
• Aspiration Pneumonia in the Geriatric Population CURRENT GERIATRICS REPORTS Ward, K. T., Nam, S., Cook, E. 2015; 4 (2): 202-209

  View details for DOI 10.1007/s13670-015-0125-x

  View details for Web of Science ID 000218590600010

• Do internal medicine residents know enough about skilled nursing facilities to orchestrate a good care transition? Journal of the American Medical Directors Association Ward, K. T., Eslami, M. S., Garcia, M. B., McCreath, H. E. 2014; 15 (11): 841-3

  Abstract

  Although many older adults require skilled nursing facility (SNF) care after acute hospitalization, it is unclear whether internal medicine residents have sufficient knowledge of the care that can be provided at this site.We developed a 10-item multiple choice pre-test that assessed knowledge of the definition of a SNF, SNF staffing requirements, and SNF services provided on-site. The test was administered to trainees on the first day of a mandatory SNF rotation that occurred during their first, second or third year of training.Sixty-seven internal medicine residents [41 postgraduate year (PGY)-1, 11 PGY-2, and 15 PGY-3] were assessed with the test. The mean number of questions answered correctly was 4.9, with a standard deviation of 1.6. Regardless of their level of training, residents had a poor baseline knowledge of SNF care (mean scores 4.2 for PGY-1, 5.3 for PGY-2, and 6.3 for PGY-3) (P < .0001). Performance on some questions improved with increased level of training but others did not.Medical residents have insufficient knowledge about the type of care that can be provided at a SNF and efforts to improve this knowledge are needed to assure proper triage of patients and safe transitions to the SNF.

  View details for DOI 10.1016/j.jamda.2014.08.004

  View details for PubMedID 25282630

  View details for PubMedCentralID PMC4591026

• Care Transitions The Wave Ward, K. T. 2012
• Palliative sedation for a patient with terminal illness. American family physician Bharadwaj, P., Ward, K. T. 2011; 83 (9): 1094-6

  View details for PubMedID 21534524

• Lack of Knowledge of Skilled Nursing (SNF) Care by Internal Medicine Residents Eslami, M. S., Ward, K. T., McCreath, H. E. American Medical Directors Association. 2010
• Revisiting the Use of Percutaneous Endoscopic Gastrostomy tubes in Patients with Advanced Dementia Palliative Care: Research and Treatment Ward, K. T., Hamilton, E. L., Bharadwaj, P. 2009
• Testing the effect of specific orders to provide oral liquid nutritional supplements to nursing home residents: a quality improvement project. The journal of nutrition, health & aging Whiteman, E., Ward, K., Simmons, S. F., Sarkisian, C. A., Moore, A. A. 2008; 12 (9): 622-5

  Abstract

  To improve nursing home (NH) staff delivery of oral liquid nutritional supplements between meals to residents with a history of weight loss.Pre-Post intervention study.Two skilled nursing homes.Eighteen long term care residents.At baseline all participants had a non-specific physician's order to receive a nutritional supplement. The intervention consisted of specifying the physician's order as follows: "Give 4 oz high protein supplement at 10 am, 2 pm, and 7 pm".Research staff conducted direct observations for two days during and between meals for a total of 4 days, or 12 possible observation periods per participant before and one week following the intervention. Research staff documented NH staff delivery of snacks (including high protein supplements) and amount consumed (fluid ounces) for the high protein supplements using a standardized protocol during each observation period.Before the specific order was written participants were offered any type of snack an average of 1.82 times per day and a high protein supplement 0.59 times per day. After the specific order was written participants were offered any type of snack an average of 1.59 times per day and a high protein supplement 0.91 times per day. There were no statistically significant differences in the average number of times snacks or supplements were offered before and after the specific order was written. The proportion of snacks offered that were high protein supplements did increase after the specific order was written (p<0.001). When a high protein supplement was provided, most residents consumed 100% of it.Oral liquid nutritional supplements were not provided consistent with orders in NH practice. The specificity of the order related to type of supplement and time of delivery did not influence when and how often supplements are provided to residents but it did influence the type of nutritional supplement offered.

  View details for DOI 10.1007/BF03008272

  View details for PubMedID 18953459

• Addressing delays in medication administration for patients transferred from the hospital to the nursing home: a pilot quality improvement project. The American journal of geriatric pharmacotherapy Ward, K. T., Bates-Jensen, B., Eslami, M. S., Whiteman, E., Dattoma, L., Friedman, J. L., DeCastro Mariano, J., Moore, A. A. 2008; 6 (4): 205-11

  Abstract

  Patients being transferred to a nursing home (NH) after an acute hospitalization are subject to adverse effects, including medication errors, related to poor coordination of care across settings.The goal of this study was to develop, implement, and evaluate the impact of a pilot intervention to improve patient safety by reducing delays in administration and omission of medications among patients discharged from the hospital to the NH.An expedited discharge protocol was developed in collaboration with hospital physician residents, hospital discharge planners, and NH staff (administrators, directors of nursing services, and licensed nurses). The intervention included education of the involved health care professionals and implementation of the expedited protocol to ensure that medication orders were transmitted to the NH-contracted pharmacy before patients' arrival at the NH. The intervention protocol was compared with a standard discharge protocol among patients aged > or =65 years being discharged from 2 university-affiliated hospitals to a single proprietary NH. The primary outcomes were the time between arrival at the NH and administration of first dose of an ordered medication; the number of omitted medications; the proportion of patients experiencing medication omissions; and the proportion of patients with omitted medications that had a low, medium, and high potential for negative consequences.The study involved 10 patients discharged from each of the 2 hospitals and transferred to the NH. Although several components of the intervention were successfully implemented, none of the medication orders were transmitted to the NH-ccontracted pharmacy before patients' arrival at the NH. All 17 patients with medications ordered to be administered in the evening had > or =1 dose of a medication omitted after their arrival at the NH. The mean (SD) delay from arrival at the NH to administration of the first dose of an ordered medication was 12.55 (7.45) hours. The mean number of doses of different medications omitted per patient was 3.4 (2.60). Sixty-seven doses of medications were omitted; 53 of these omissions involved only 1 dose of a medication. Thirty-three percent of omitted doses involved medications with the highest potential for resulting in a negative consequence.The intervention to improve patient safety by reducing medication delays for patients making the transition from the hospital to the NH was not successfully implemented, as medication orders were not transmitted to the NH-contracted pharmacies before patients' arrival at the NH. All patients making the transition from hospital to NH experienced a >12-hour delay in medication administration, and the mean number of missed doses of medications was >3. There is a need for further exploration of the reasons for and possible solutions to delays in medication administration during the transition to the NH, as well as of the impact of such delays on patient outcomes, including adverse drug events, emergency department visits, and rehospitalizations.

  View details for DOI 10.1016/j.amjopharm.2008.10.001

  View details for PubMedID 19028376

• Ethical considerations of patients with pacemakers. American family physician Bharadwaj, P., Ward, K. T. 2008; 78 (3): 398-9

  View details for PubMedID 18711956

• Risks of combined alcohol/medication use in older adults. The American journal of geriatric pharmacotherapy Moore, A. A., Whiteman, E. J., Ward, K. T. 2007; 5 (1): 64-74

  Abstract

  Many older adults (ie, those aged >65 years) drink alcohol and use medications that may be harmful when consumed together.This article reviews the literature on alcohol and medication interactions, with a focus on older adults.Relevant articles were identified through a search of MEDLINE and International Pharmaceutical Abstracts (1966-August 2006) for English-language articles. The following medical subject headings and key words were used: alcohol medication interactions, diseases worsened by alcohol use, and alcohol metabolism, absorption, and distribution. Additional articles were identified by a manual search of the reference lists of the identified articles, review articles, textbooks, and personal reference sources.Many older adults drink alcohol and take medications that may interact negatively with alcohol. Some of these interactions are due to age-related changes in the absorption, distribution, and metabolism of alcohol an medications. Others are due to disulfiram-like reactions observed with some medications, exacerbation of therapeutic effects and adverse effects of medications when combined with alcohol, and alcohol's interference with the effectiveness of some medications.Older adults who drink alcohol and who take medications are at risk for a variety of adverse consequences depending on the amount of alcohol and the type of medications consumed. It is important for clinicians to know how much alcohol their older patients are drinking to be able to effectively assess their risks and to counsel them about the safe use of alcohol and medications. Similarly, it is important for older adults to understand the potential risks of their combined alcohol and medication use to avoid the myriad of problems possible with unsafe use of these substances..

  View details for DOI 10.1016/j.amjopharm.2007.03.006

  View details for PubMedID 17608249

  View details for PubMedCentralID PMC4063202