Value Driven Healthcare and Geriatric Medicine by James S. Powers

Author:James S. Powers
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Medications: Potentially inappropriate medications (PIMS) can compromise resident well-being

Mobility: Enhancing and maintaining mobility maintain physical and psychological well-being

Pain: Inadequate pain management can affect activity and quality of life

Pressure ulcers can be painful and dangerous to residents

Many other new care models are too new to have robust results. The patient-centered medical home provides increased care between visits, is nurse managed, and is associated with as many as 20% fewer required return outpatient visits, expanding the opportunity for new patients [42]. This model however requires initial investment of approximately 2.5 personnel per full-time practicing clinician and uptake has historically been slow under fee-for-service models. Telehealth or clinic-based video telehealth (CVT) visits for mental health, dementia, palliative care, and nursing home care patients has been very effective for goals of care discussion, symptom management, and caregiver support and provides more immediate consultation services for patients including a distance from major medical centers [43].

Emergency rooms are experiencing increased utilization. From 2003 to 2009 there was a 17% increase in admissions from emergency room and a corresponding 10% decrease in admissions from office practices, suggesting that office-based physicians are increasingly relying on emergency departments to evaluate complex patients with potentially serious problems [44]. Another key driver of unnecessary emergency room use is lack of access to primary care. Some potential ways to improve care transitions in the emergency department to reduce return to the emergency department include case management, reducing potentially unnecessary medications [45], and improved coordination with primary care and specialty practices.

Healthcare hotspotting is a data-driven process developed by the Camden Coalition of healthcare providers for the timely identification of outlier patterns in a defined region of the healthcare system. Hotspotting utilizes claims data to guide targeted intervention and follow-up to better address patient needs, improve care quality, and reduce cost. Hotspotting can help reveal both a community’s healthcare problems and their solutions and identify heavy utilizers to focus on this population [46].

Elements of the patient-centered medical home can be infused into healthcare systems with benefits to patients as well as the healthcare system. Proactive home visits utilizing paramedics provide level I patient assessments to frail and homebound elderly, engaging community supports and providing critical information to primary care providers. Paramedics trained in geriatric principles have been able to provide assessments of general health, frailty, social, cognitive, and functional abilities and share this information with primary care providers in order to develop care plans, obtain appropriate referrals, and introduce interventions. The Toronto Common Health Evaluation Completed Using Paramedicine Services (CHECUPS) that has permitted the development of partnerships with community providers has been found to benefit elderly individuals who are frequent utilizers of the healthcare system and to correct modifiable issues [47] and has shown a 47% reduction in 911 calls within a 6-month period [48]. Some models are also operating in the United States, termed mobile integrated healthcare and community paramedicine (EMS-MIH-CP), an emerging healthcare trend that is improving the lives of patients and transforming the role of the nation’s emergency medical services, paramedics, and emergency medical technicians (EMTs).

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