"Today's primary care physicians are often overwhelmed by the complex needs of patients with multiple chronic health challenges, such as diabetes, high blood pressure, arthritis and more," said Boult. "Current medical training often does not prepare physicians to provide the comprehensive support that these patients require. Through our research, we identifed four processes that can improve how we care for these patients, and three models that include these critical processes."
Boult and Wieland reveiwed all peer-reviewed studies of comprehensive primary care models for older adults with multiple conditions published between 1999 and 2010. From this review, they identified four processes that are present in most successful models of primary care for these patients:
A comprehensive patient assessment that includes a complete review of all medical, psychosocial, lifestyle and values issues,
Creation and implementation of an evidenced-based plan of care that addresses all of the patient's health-related needs,Communication and coordination with all who provide care for the patient, and
"Most of today's primary care does not include these four processes, so patients receive fragmented and inefficient care that is further undermined by a lack of family and community support, " said Wieland, research director of Geriatrics Services at Palmetto Health Richland Hospital. "However, new models of primary care that include these processes have improved health outcomes, and patient and physician satisfaction, and have in some cases lowered the cost of care."
Boult and Wieland identified three models of care that have the greatest potential to improve effectiveness and efficiency of complex primary health care. All three models include a team-based approach to primary care, and they provide many of the same services to complex older patients, beginning with a comprehensive assessment and an evidence-based care plan. All of these models include proactive monitoring and coaching, coordination of care across all sites of care, support of patient's transitions from acute to post-acute settings, and access to community-based agencies.GRACE (Geriatric Resources for Assessment and Care of Elders), a team-based intervention developed by researchers from Indiana University and the Regenstrief Institute. In a large clinical trial, GRACE improved the quality of care, decreased emergency department visits, and lowered hospital admission rates and costs in a group at high risk for hospital admission.
Guided Care, a multi-disciplinary model of comprehensive primary care for people with multiple chronic conditions, was developed by Johns Hopkins researchers. Early results from a multi-site, randomized controlled trial indicate that Guided Care improves the quality of patients' care, improves physician's satisfaction with some aspects of chronic care, and tends to reduce the use and cost of expensive health-related services.
Of the three models, only PACE is currently reimbursable through Medicare and state Medicaid programs.
"While most of the programs noted here are not yet widely available, we are hopeful that new initiatives launched by the Patient Protection and Affordable Care Act of 2010 will provide new opportunities for primary care physicians to care for their chronically ill patients more effectively and efficiently," said Boult. "More research is needed to define the optimal methods for identifying the patients who will benefit most, for providing the essential clinical processes, for disseminating and expanding the reach of these models, and for paying for excellent chronic care."
Tim Parsons | EurekAlert!
Study tracks inner workings of the brain with new biosensor
16.08.2018 | Rheinische Friedrich-Wilhelms-Universität Bonn
Foods of the future
15.08.2018 | Georg-August-Universität Göttingen
New design tool automatically creates nanostructure 3D-print templates for user-given colors
Scientists present work at prestigious SIGGRAPH conference
Most of the objects we see are colored by pigments, but using pigments has disadvantages: such colors can fade, industrial pigments are often toxic, and...
Scientists at the University of California, Los Angeles present new research on a curious cosmic phenomenon known as "whistlers" -- very low frequency packets...
Scientists develop first tool to use machine learning methods to compute flow around interactively designable 3D objects. Tool will be presented at this year’s prestigious SIGGRAPH conference.
When engineers or designers want to test the aerodynamic properties of the newly designed shape of a car, airplane, or other object, they would normally model...
Researchers from TU Graz and their industry partners have unveiled a world first: the prototype of a robot-controlled, high-speed combined charging system (CCS) for electric vehicles that enables series charging of cars in various parking positions.
Global demand for electric vehicles is forecast to rise sharply: by 2025, the number of new vehicle registrations is expected to reach 25 million per year....
Proteins must be folded correctly to fulfill their molecular functions in cells. Molecular assistants called chaperones help proteins exploit their inbuilt folding potential and reach the correct three-dimensional structure. Researchers at the Max Planck Institute of Biochemistry (MPIB) have demonstrated that actin, the most abundant protein in higher developed cells, does not have the inbuilt potential to fold and instead requires special assistance to fold into its active state. The chaperone TRiC uses a previously undescribed mechanism to perform actin folding. The study was recently published in the journal Cell.
Actin is the most abundant protein in highly developed cells and has diverse functions in processes like cell stabilization, cell division and muscle...
17.08.2018 | Event News
08.08.2018 | Event News
27.07.2018 | Event News
17.08.2018 | Physics and Astronomy
17.08.2018 | Information Technology
17.08.2018 | Life Sciences