This week, a RAND research team published a report in the Journal of the American Medical Association (JAMA) on a three-year evaluation of Patient-Centered Medical Homes in Pennsylvania, funded by the Commonwealth Fund and Aetna. Since, like almost everyone else, we believe in the potential benefits of enhanced primary care, this is an important paper.
However, its implications are very complicated. I believe the results confirm concerns I had from the beginning that this kind of project wouldn’t work. Why? Because it wasn’t focused enough on the complexly ill and it didn’t incorporate enough special expertise in their care.
The evaluation was led by Mark Friedberg, MD, and used a pre-post, matched practice/patient design where 32 practices worked to become medical homes. The outcomes of the practices and the patients were tracked over three years. A non-random comparison group was created by looking at other practices and patients followed over the same time period to serve as a contrast group not implementing medical home elements.
Having lived in New York City for many years now, I’ve grown used to the blare of ambulance sirens. Still, when I hear one go by, I sometimes find myself saying a little prayer of hope that the patient onboard makes it OK through the insane city traffic.
These past few weeks, however, ambulances and emergency medical technicians (EMTs) were on my mind even more than usual. First, I received an inquiry from a geriatrician trying to develop an EMT intervention for the care of older adults and looking for the appropriate quality measures to use. I pointed her to Beeson Scholar Manish Shah at the University of Rochester, who has done innovative work in this area.
Then, I attended a meeting of a Community Action Board for a project led by the emergency department at Mount Sinai Medical Center: the GEDI-WISE program. The project aims to improve health and reduce costs for older emergency room patients
While still shrouded in mist, the path to transforming our health care system is becoming more clear.
While the view is still hazy, last week the Centers for Medicare and Medicaid Services (CMS) took a major step to clarify how it will address the major challenge facing Medicare (and therefore our health care system): transforming an episodic, acute-care dominated, fee-for-service system into one that can meet the challenge of complex chronic care, improving the health of older people while reducing spending.
This is the challenge our new “downstream” grantmaking strategy is designed to address, making CMS’s proposal both very welcome and a high-stakes opportunity to advance our hopes.
As somebody who actually enjoyed studying statistics and quality improvement, the focus of the new funding portfolio I oversee—Tools and Measures for Quality Care—sets my pulse racing.
But I’ve been around enough to know my enthusiasm for constructing statistical measures of performance isn’t universal and that the greater good would be served if I explained our goals and why this initiative means a lot to all of us, whether we’re patients, caregivers, providers, payers, policy wonks, or other stakeholders.
In recent blog posts, my colleagues Rachael Watman , Nora O’Brien Suric, and Amy Berman introduced the John A. Hartford Foundation‘s objectives in developing three of our other new grant portfolios —Leadership in Action, Linking Education to Practice, and Models of Care—and gave examples of how we plan to execute our “downstream” strategy. Next Thursday, Marcus Escobedo will explain the fifth and final new funding area: Policy and Communications.
Sarah Szanton, PhD, CRNP (photo from Johns Hopkins Nursing Magazine)
At the John A. Hartford Foundation, we are well on the path to implementing our new strategic plan focused on putting geriatrics expertise to work in health care delivery and practice change.
As I described in last week’s post introducing one of our new strategic funding areas – Leadership in Action – one of our primary strategies will be to engage the community of experts in geriatric social work, medicine, and nursing that we have supported for more than 20 years. We will now support them to join forces in inter-professional teams to implement evidence-based best practices, change policy that will drive improvements in health care delivery, and take other actions to improve the health of older adults. We will accomplish this in part through one of the Leadership in Action’s primary grant programs, the Change AGEnts initiative, which was just approved by our Trustees.
Dr. William Dale, author of “Geriatrics Saved His Life!” The story took top prize in this year’s John A. Hartford Foundation Heroes of Geriatric Care Story Contest.
Too often when older adults enter the health care system, we hear stories about them not receiving recommended care, such as medications reviews, fall prevention assessments, and depression screenings. Older adults also experience too many adverse events in the hospital, poor handoffs between care settings, and preventable hospital readmissions.
And too many times, they enter this system lacking the advocates who can expertly provide or coordinate their often complex care.
Drs. Jan Busby-Whitehead, right, and Kevin Biese lead a collaborative project at UNC-Chapel Hill that is improving care for older adults.
Recently, I visited the University of North Carolina at Chapel Hill to see firsthand a collaborative project that has been developed over the past year by faculty in UNC’s Division of Geriatric Medicine and Department of Emergency Medicine and to meet with our colleagues at the William R. Kenan Jr. Charitable Trust.
The initiative’s leaders are Drs. Jan Busby-Whitehead, Chief of the Division of Geriatric Medicine, and Kevin Biese, an emergency medicine physician and geriatrics educator and researcher. They are working to develop a unique model of a geriatric emergency department (ED) focused on improving care transitions.