NorTex 2016 Spring Newsletter

March 30, 2016 • NorTex

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The North Texas Primary Care Research Network Newsletter


NorTex is excited to be a part of the Workforce Enhancement Health Aging and Independent Living (WE HAIL) initiative. In Tarrant County, adults 65 years and over are projected to increase by more than 26% from 2013 to 2018. By 2018, individuals 65 and over will make up nearly 12% of the total population compared to almost 10% in 2013. The increase in this population is expected to have a dramatic impact on the amount and types of services required by the community, especially due to the fact the most people in the age group will need to manage more than once chronic condition by 2030. This is compounded by he fact that across the region, access to care due to provider shortage and capacity was highlighted as a core issue in Tarrant County in the John Peter Smith (JPS) Community Health Needs Assessment. Furthermore data from the Health Resources and Services Administration (HRSA) show Health Professional Shortage Areas (HPSAs) in Tarrant County and surrounding rural counties. The recruitment and retaining of qualified geriatric healthcare professionals is key to the development of a highly trained workforce in our community.Spring 2016 2

To address these issues, Dr. Janice Knebl at the UNTHSC and Dr. Elizabeth Carter at JPS Health Network recently received a $2.55 million HRSA grant. The purpose of this project, titled “Workplace Enhancement Health Aging and Independent Living” (WE HAIL), is to increase the number of healthcare workers in Tarrant County and surrounding rural counties to address and meet the needs of older adults at individual, community, and population levels. Essential, WE HAIL is designed to break down silos in the area od health for older adults through building collaborations. Through five areas of innovation, the project aims to focus on the training of healthcare professionals (undergraduate, graduate, residents, and practicing) in geriatrics, and to take leadership roles in geriatric care. NorTex will primarily be involved in distributing materials to practicing clinicians and offering maintenance of certification and quality and improvement opportunities to our practices. WE HAIL will ultimately provide training in health literacy, chronic disease self-management, falls prevention, medication management, and dementia care.

WE HAIL includes multiple community and academic partners. Institutional partners include the UNTHSC, JPS Health Network, Texas Christian University, and United Way of Tarrant County. Community partners include Meals on Wheels Inc. of Tarrant County, Senior Citizen Services of Greater Tarrant County Inc., James L West Alzheimer’s Center, and the Alzheimer’s Association of North Central Texas.

For more information about WE HAIL, please contact Dr. Jennifer Severance at or Subhada Prasad at 



Improving Birth Outcomes: The Essential Role  of Primary Care Providers in Reproductive  Life Planning

NorTex is collaborating with Tarrant County Public Health Department, ForHER, the Office of Professional and Continuing Education (PACE) at the UNTHSC to study reproductive life planning in primary care practice. At 6.87 deaths per 1,000 live births in 2012, the Tarrant County infant mortality rate (IMR) was higher than the rates of Texas (5.98 per 1,000) and the United States
(5.82 per 1,000). The first goal of our collaboration is to identify primary care providers’ educational and behavioral needs for incorporating reproductive life planning. The second goal is to identify, quantify, and clarify barriers to providing reproductive life planning in primary care settings. There are several components to the overall project including a continuing medical education event (CME), focus groups, and surveys for physicians, physician assistants, nurse practitioners, and nurses from primary care clinics.

The survey portion of the project was completed by 149 primary care clinicians. Survey results revealed providers’ obstacles to providing reproductive life planning in their practice included factors such as lack of time with patients (37%) and inadequate / insufficient information (brochures, posters, flyers, etc.) to provide to the patient (31%). Additionally, providers indicated the need for educational materials on reproductive life planning (57%) and believed inclusion of reproductive life planning questions into the electronic medical record (47%) would be helpful. Of the providers who completed the survey, 83% were unaware of the Texas Department of State Health Services “Someday Starts Now” public awareness campaign.

This project is funded by Tarrant County Public Health Department through a grant received from the Texas Department of State Health Services.


Development and Validation of a Clinically Practical Patient Assessment: Engagement, Literacy, and Adherence (P-ELA)

NorTex collaborated with the Kentucky Ambulatory Network to develop a clinical tool useful to primary care physicians. The three constructs of: patient engagement in care, health literacy, and medication adherence are especially impactful to health outcomes. The application of a brief and accurate measure of these concepts could contribute enormously to improved patient-centered primary care. The objective of our collaboration was to address the lack of measures for these three important constructs by developing an ultra-brief battery, called the Patient-ELA (Engagement, Literacy, Adherence) tool that will equip primary care clinicians with patient-level information so that they can approach and interact with their patient at an individualized level. Using data collected from 200 primary care patients, item response theory (IRT) analysis identified discriminant items from among seven existing scales targeting engagement, literacy, and adherence. Seven items were selected for inclusion in the P-ELA, including one engagement; three literacy items; and three adherence items. These items were highly informative at low levels of engagement, literacy, and adherence (as measured by the full existing instruments) and demonstrated moderate to strong concordance in identifying patients “at-risk” in each of these areas. A rapid screening tool may accurately identify patient characteristics that act as barriers to a clinical treatment plan. With further evidence of validity, adoption of P-ELA could allow clinical practices to rapidly identify and monitor high-risk patients.
This project was funded through a University of Kentucky Center for Clinical and Translational Sciences (CCTS) small grant award.


Spring 2016 3Dr. Steven DeKosky was destined to lead the way in Alzheimer’s disease research. He began working with Alzheimer’s in 1980, when very few people in the United States knew what it was or how widespread it was going to become. “As somebody who early on was educated about Alzheimer’s, when determining my area of research, I realized I would love to work in memory because that is one of the primary things that disintegrates with Alzheimer’s disease.” After medical school, Dr. DeKosky tailored his post-doctoral work to ensure he could continue to conduct brain research while taking care of people. His primary focus was to learn all he could about how the brain controls and relates to language, memory and the integration of visual and perceptual information.
Physicians and scientists, as well as family and healthcare professional caregivers will have the opportunity to hear Dr. KeKosky’s keynote address at the 13th Annual Alzheimer’s Association Spring Symposium, Moving Forward in Care, Research and Treatment. This educational event will be held at the Arlington Convention Center (1200 Ballpark Way, Arlington, Texas 76011) on Thursday, March 31, 2016 starting at 8:30 am. The physician’s and scientist’s half-day educational track will be offered in the morning, and the family and healthcare professional caregiver tracks will encompass a full-day of education. DeKosky will kick off the day with his keynote address, Progress in Alzheimer’s Diagnosis and Treatment. Physicians and scientists will also learn about the following topics:

  • Cognitive Assessment during Annual Wellness Visit -Janice Knebl, DO and Nicky Brown, LMSW
  • National Registry’s Impact on Local Dementia Research – Sid O’Bryant, PhD and Keith Fargo, PhD
  • Differential Diagnosis of Dementing Diseases – Steven DeKosky, MD, FACP

Steven DeKosky, M.D., currently serves as interim executive director of the Evelyn E. and William L. McKnight Brain Institute of the University of Florida and is a professor of neurology in the College of Medicine. “We are proud to have Dr. DeKosky here to talk to caregivers, physicians and scientists about the latest findings in Alzheimer’s research and the latest treatments for the disease,” said North Central Texas Chapter President and CEO Theresa Hocker. “Dr. DeKosky has served in leadership roles at the National Institutes of Health and is a member of the American Board of Psychiatry and Neurology, and he definitely is one of the foremost experts for the latest information about Alzheimer’s.”
The physician’s and scientist’s educational track offers 4.25 hours of AOA Category 2A CME credits. Healthcare professionals including nurses, social workers, activity professionals, licensed nursing facility managers, etc., are eligible for six units of Continuing Education. The fee for all professional attendees seeking CEUs or CMEs is $100 per person. Family caregivers are welcomed at no charge.
To view session details and register, please visit our chapter website at or call 800-272-3900.


Janice Knebl, DO

Spring 2016 4Dr. Knebl received her medical degree at the Philadelphia College of Osteopathic Medicine, after which she completed an Internal Medicine Residency at Geisinger Medical Center in Danville, Pennsylvania and a Geriatrics Medicine Fellowship at the Philadelphia Geriatrics Center. In 2002, Dr. Knebl completed an MBA at Texas Christian University. She is the Director of the Center for Geriatrics within the Institute for Healthy Aging and the Chief, Geriatrics Service Line and the Dallas Southwest Osteopathic Physicians Endowed Chair in Geriatrics at the UNTHSC Texas College of Osteopathic Medicine (TCOM). She is the Director for the Reynolds Interprofessional Geriatrics Education and Training in Texas Program and the Medical Director for several long term care communities in Fort Worth, including James L. West Alzheimer’s Center, Silverado Assisted Living and the Stayton Continuing Care Retirement Community. More recently, under her leadership as Project Investigator, UNTHSC expanded unique partnerships with JPS Health Network, Texas Christian University and the United Way’s Area Agency on Aging of Tarrant County to create the Workforce Enhancement in Healthy Aging and Independent Living (WE HAIL) Program. As the only HRSA Geriatric Workforce Enhancement Program (GWEP) awarded in Texas and one of only 44 awardees in the nation, Dr. Knebl’s vision for strategic and cross-sector innovations will transform clinical training environments for geriatric health care professionals. “It’s an honor to be awarded,” said Dr. Knebl. “We are collaborating across academic institutions, a county hospital and the aging network to improve the quality of care for older adults in Tarrant County and its surrounding rural communities,” said Dr. Knebl.
Dr. Knebl’s dedication to healthy aging and Alzheimer’s care for over 25 years has gained professional and community recognition. She has been named as a “Fort Worth Top Doc”, received the distinguished “Internist of the Year” Award from the American College of Osteopathic Internists, and has been awarded the 2013 TCOM Dean’s Research Award. She has been the recipient of aging research grants from agencies such as American Federation for Aging Research, Bureau of Health Professions, Alzheimer’s Association, Texas Consortium on Alzheimer’s disease (TARC) and Texas’ Department of Health and Human Services. Her lengthy list of publications and articles are on subjects including understanding Alzheimer’s disease, primary care and geriatrics, stages and evaluation of dementia, delirium and dementia in the hospitalized elderly.

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