GSA 2018 Annual Scientific Meeting As the nation’s largest integrated healthcare system, the Veterans Health Administration (VHA) is faced with challenges in caring for a growing number of older adult Veterans with comorbid medical, mental health, neurocog- nitive, and behavioral care needs. These Veterans can pose signifcant risk of harm to self or others and can lead to inef- fcient, ineffective, or inappropriate use of VHA resources. Using an implementation science framework, this presen- tation will describe the development and expansion of the Care of Patients with Complex Problems (CP)^2 Program, outcomes, and implications. A national needs assessment of 138 VHA medical centers estimated 42% of inpatient beds are occupied by Veterans with complex problems, with 38% indicating access to inpatient care related challenges. Through leadership feedback and group consensus, an inter- disciplinary task force and a VHA senior leadership steering committee selected one of six promising practices to launch the (CP)^2 Program. The key components of the program include: dissemination of promising practices; a national learning collaborative and webinar series (participation averaging 200 staff/month); and centralized technical assis- tance. Three medical centers were invited to participate in the initial launch of the program with a regional dissemination of the promising practice model that supports transitioning Veterans from inpatient care to more appropriate and less costly community settings. Following promising outcomes (i.e. reductions in costs and hospital readmissions) and over 30 briefngs/stakeholder meetings, support was garnered for a national training and expanded dissemination of the model. Implications for practice, development of VHA/com- munity partnerships, and lessons learned were identifed. USING NATIONAL QUALITY REGISTRIES IN GERONTOLOGICAL RESEARCH: PROS AND CONS M. Ernsth Bravell 1 , L. Johansson 2 , D. Finkel 3 , 1. Jonkoping University, 2. Institute of Gerontology, Aging Research Network-Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden, 3. Indiana University Southeast Health care in Sweden usually focuses on single diseases and is less prepared to treat people with multimorbidity. Combining different national quality registries (NQR) can provide a broader picture of health care, preventive care, and health-promoting care of older people with multimorbidity. The aim of this study was to explore how NQRs can be used in gerontological health care research. A descriptive mixed- method study, including a case report and statistical ana- lysis, was performed. Nine National Quality Registries, three health registries and a social care registry maintained by the Swedish government were individually matched to an older population (birth year 1896 to 1958) in the Swedish Twin Registry (n≈44000). Factor analysis demonstrated the people tended to fall into one of 4 clusters of registries: stroke/de- mentia/hip, heart/diabetes, arthritis-related, and other. Men were more highly represented in the heart/diabetes cluster. People in the arthritis cluster had the lowest mean age; people in the stroke/dementia/hip cluster had the highest mean age. 161 people were identifed as “most ill elderly” (according to the defnition by the Swedish government). Two of them were randomly selected for case reports. Each case appeared in 6–7 of the health quality registries, providing suffcient in- formation to track their progression through the health care system until the point of death. The results highlight both pros and cons of using the quality registries as the basis for analysis and “registry-enriched” research designs, but more research needs to be performed to understand how NQRs can be used in gerontological research. WHAT MATTERS MOST: A PILOT STUDY TO DEVELOP QUALITY MEASURES FOR OLDER ADULTS WITH COMPLEX NEEDS E. Giovannetti, S. Sandberg, B. Angelia, S. Baird, C. Clair, S. Scholle, National Committee for Quality Assurance (NCQA) Healthcare quality measures aim to evaluate providers and health plans so that consumers can make informed deci- sions on aspects of quality that matter most to them. Yet, most existing quality measures are based on a narrow set of health outcomes and do not effectively evaluate outcomes that are important to individuals themselves. This “one-size- fts-all” approach to measurement is particularly misaligned when evaluating care for older adults with complex needs. This population—including those with functional limita- tions, comorbidities, or both—frequently requires services and supports that extend beyond traditional medical care, and choices about treatment options that require com- plicated calculations of tradeoffs. To address the need for quality measures that refect what matters most to individu- als, we tested two approaches to personalized goal setting: goal attainment scaling (GAS) and person-reported outcome measures (PROM). Across six organizations, 34 clinicians (including physicians, nurse practitioners, registered nurses, and social workers) piloted the approaches with 232 older adults (GAS n=184; PROM n=49). Results demonstrate that older adults articulated a range of personalized outcomes im- portant to them but not captured through current quality measures. Quantitative analyses show that on average 73% of older adults in the study with follow-up achieved the per- sonalized goal they had selected over six months, but also revealed variation in achievement rates across organizations (range: 56–100%). Qualitative results highlight that despite the greater initial perceived workload, providers and older adults preferred the individualized GAS approach to the more structured PROM approach. GAS proved feasible for quality measurement across diverse settings of care. SESSION 855 (POSTER) PAIN: FUNCTION, SYMPTOMS, AND MANAGEMENT A LONGITUDINAL ANALYSIS OF THE RELATIONSHIPS BETWEEN DEPRESSION, FATIGUE, AND PAIN J. Sheffer 1 , D. Bekelman 2 , S. Schmiege 2 , J. Sussman 3 , 1. Florida State University, 2. University of Colorado, Denver, 3. Denver VAMC Objectives: This study examined longitudinal pathways among depression, pain, and fatigue in the context of a ran- domized clinical trial (RCT). Further, we tested whether a collaborative symptom and psychosocial care intervention Innovation in Aging, 2018, Vol. 2, No. S1 149 Downloaded from https://academic.oup.com/innovateage/article/2/suppl_1/149/5170176 by guest on 10 March 2023