As Orson Welles might have said: “We will evaluate no program before its time.”
One of the first things you learn in “foundation school” is how easy it is to kill even great programs by evaluating them before they are ready.
Nothing innovative starts working on day one as well as it will with practice, adjustment, and refinement. Even more deadly is an evaluation with low-cost methods that doesn’t really provide the information you want and need. One of the painful lessons I’ve learned is to always buy the highest quality and therefore most expensive evaluation you can afford, because it’s cheaper in the long run.
“Whoever said nothing is impossible obviously hasn’t tried nailing Jell-O to a tree.”—John Candy
As the year comes to a close, there are many lists of the best and worst in almost every imaginable category for 2014. Here at Health AGEnda, we have made an annual practice of reviewing the workforce in training data—specifically, the number of graduating resident physicians choosing additional training in geriatric fellowship programs—published in the Journal of the American Medical Association (JAMA). (Read Boxing Day Brings Glad Tidings for Geriatrics Field from 2013, Decline in Geriatric Fellows Defies Pay Boost: +10% = -10% from 2012 and Falling Leaves, Falling Numbers from 2011.)
I recently saw one of my charts presented (without attribution ) in a Washington briefing session on the workforce available to care for older adults, so I guess I have to keep updating them.
The opening session of the Hartford Change AGEnts Conference in Philadelphia last week.
Last week was the capstone of the first-year rollout of the Hartford Change AGEnts Initiative. This projects aims to engage and support all prior John A. Hartford Foundation health and aging grantees to focus on making systematic, large-scale practice change in the care of older Americans.
More than 160 Change AGEnts converged on Philadelphia for an intensive, day-and-a-half conference that was packed from start to finish with opportunities to learn, share knowledge, and network with others from different parts of the country and different disciplines. It was an energizing experience, not only because it gathered so much of the Hartford Foundation’s most precious assets—its people—in one place, but also because we learned more about the work already underway to improve care. We also saw new relationships and ideas emerge that will advance our mission.
For almost 20 years, the Gerontological Society of America (GSA) has been one of the John A. Hartford Foundation’s key grantee partners.
The organization served first as the home of the Geriatric Social Work Initiative (GSWI), then as the coordinating center for the National Hartford Center of Gerontological Nursing Excellence (NHCGNE) , and most recently, as the basecamp of the Hartford Change AGEnts Initiative.
So the GSA annual meeting, being held this week in Washington, DC, is a tremendous opportunity to connect with long-standing friends and meet new ones in the field of aging, as well as to check in on long-ago grants and plan new ones.
Last week, the Journal of the American Medical Association (JAMA) published a large and well-designed study of a post-hospital readmission reduction program called the “virtual ward,” which grew up in the UK and was tested by our cousins to the north in Toronto.
The model partakes of some elements of other evidence-based work done by John A. Hartford Foundation grantees, including Mary Naylor’s Transitional Care Model, the Society of Hospital Medicine’s Project BOOST, and Eric Coleman’s Care Transitions Intervention.
A press release and JAMA Report video are available for those who don’t subscribe to JAMA.
Last week, the Institute of Medicine released a new report titled Dying in America.
The committee that worked on the report included some long-time grantees and friends of the John A. Hartford Foundation, such as June Simmons of the Partners in Care Foundation, Jean Kutner, a Beeson Scholar and faculty member at the University of Colorado, Diane Meier, leader of the Center to Advance Palliative Care, Patricia Bomba of Rochester, NY’s Excellus Blue Cross/Blue Shield, and Joan Teno of the Center of Excellence in Geriatric Medicine at Brown University.
As always, we are proud to be associated with leaders who give their time to explore such urgent issues.
Ever since I began working as a program officer at the John A. Hartford Foundation, I’ve tried to do my best to put myself in the shoes of the health professionals with whom we’ve worked and whose education and training historically has been one of our main concerns.
I’ve often found memoirs and other lightly fictionalized accounts to be the best way to get into the culture and daily experience of these health professionals. I’ve read Samuel Shem’s The House of God, countless memoirs of nurses and physicians, and even a very affecting memoir of a nurse’s aide in a nursing home.
One of the tricks of such reading is that we experience what our imagination and the author’s words together conjure in a special state of willing suspension of disbelief. Psychological research suggests that this process of imagination and purposeful lowering of critical skepticism is, in fact, what makes fiction so persuasive and engenders the feeling that novelists understand a truth about human character that other ways of knowing can’t match.
Yesterday, the New York Times had an interesting piece looking at the star rating system that Medicare has been using to evaluate long-term care facilities.
Coincidentally, I was moved to learn that a family friend, my “Aunt Betsy,” has been in an institution for going on 10 years, exceeding almost every expectation for longevity in advanced dementia.
The Times writer, Katie Thomas, observes that much of the data that drives this public reporting system, Nursing Home Compare, of “hotel-like,” 1- to 5-star ratings comes from institutional self-report and seems susceptible to gaming—including staffing up for the critical two weeks that are the basis of reporting for the year’s rating, and then letting the staff go immediately afterward. Sort of the way that television shows pump up their ratings with guest stars during sweeps week and then fall back to meh afterwards.
From left, featured experts Peggy O’Kane, Robert Berenson, and Caroline Blaum listen intently.
Like so many stakeholders in health care, we at the John A. Hartford Foundation have many of our hopes pinned on enhanced primary care as a way of improving health outcomes, particularly for older Americans who face multiple chronic conditions.
Primary care providers will need more skills, more teammates, community partners, and, of course, more money, to live up to these hopes. But we believe that better primary care can prevent some of the acute and expensive events such as hospitalizations that they experience, and thereby also lower total costs of health care.