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GWEP-CC Small Grants for Consults - Innovative Geriatrics Programs and Approaches to Care Application, Second Round
1.
Name of GWEP Site
2.
Contact Information
Applicant Name
Title
Mailing Address
Email
Phone
3.
Briefly describe the GWEP program goal(s) that are relevant to this request.
4.
With which program/approach do you wish to consult? Please choose from the drop-down list:
Acute Care for the Elderly (ACE) Unit
AGS CoCare: Ortho
Care Transitions Intervention
Center to Advance Palliative Care (CAPC)
Collaborative Care
Community Catalyst
Geriatric Interprofessional Team Transformation in Primary Care (GITT-PC)
GRACE Team
Guided Care
HomeMeds
Hospital at Home
Hospital Elder Life Program (HELP)
Nurses Improving Care for Health System Leaders (NICHE)
Program for All-Inclusive Care of the Elderly (PACE)
Transitional Care Model (TCM)
5.
How will this consultation help you achieve your program aims and objectives? (Please be specific)
6.
What is the local need addressed by the proposal? Describe the gap in care that you are aiming to fill. (Provide any relevant data)
7.
When implemented, what is the anticipated impact that the program would have on the health care environment or community?
8.
Submit a general timeline for consultation and possible implementation.
9.
Following a consult, what do you anticipate as your next step(s) to move the program forward?
10.
Have you identified a champion within your health care system or community (as applicable)? A champion outside of the GWEP leadership may be needed to assist in program implementation. If so briefly describe that individual (role, title) and why is this individual a good fit for the project.