Category Archives: Team Care

Dr. Eckstrom: ‘Cultural Shift’ Needed to Improve Care of Older Adults

Elizabeth Eckstrom, MD, MPH

Geriatrician Elizabeth Eckstrom, MD, MPH, shares her professional perspective on caregiving in the book she co-authored, The Gift of Caring.

Valentine’s Day is just around the corner, and gift giving will abound. It makes me think of those who give the gift of selflessly caring for others, such as those family and friends who care for their older adult loved ones.

There are many resources to help these family caregivers. The Gift of Caring: Saving Our Parents from the Perils of Modern Healthcare is one new resource that shares both a personal and professional perspective on caring for older adults.

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Telling Our Story

Click on image to read the article.

Click on image to read the article.

A headline in Tuesday’s New York Times asks a very important question: “As the population ages, where are the geriatricians?

The story, by Katie Hafner, describes the shortage of geriatrics and gerontologic expertise in our health system today. It features the important and compelling work of our colleague Elizabeth Eckstrom, MD, and her team at Oregon Health and Science University, where we have funded a number of grant projects, notably in geriatric nursing and care models. The story also features comments from several John A. Hartford Foundation Change AGEnts who work every day to share their precious expertise in caring for older adults.

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A Model CAPABLE of Creating Lasting Change

This is the fourth in a series of six Health AGEnda posts on the 2014 Annual Report.

This is the fourth in a series of six Health AGEnda posts on the 2014 Annual Report.

Editor’s Note: The John A. Hartford Foundation’s 2014 Annual Report features five profiles of Hartford Change AGEnts whose work is representative of the kinds of practice and policy change the initiative is making. Read Harnessing the Power of Hartford Change AGEnts for more on the Change AGEnts Initiative. In the coming weeks, the Health AGEnda blog will spotlight the stories and videos of the other Hartford Change AGEnts profiled in the Annual Report. Today, we meet Sandra Spoelstra, PhD, RN, who has leveraged a $10,000 Change AGEnts Action Award into more than $1.2 million in private and public funding for the MiCAPABLE program, which is improving care for vulnerable older adults in Michigan.

Supported by a $10,000 John A. Hartford Foundation Change AGEnts Action Award, a small pilot program to provide team-based home care and home repair services to a handful of people in Saginaw, Michigan, has blossomed into a larger effort to help 270 of the state’s most vulnerable older adults in three cities stay in their homes and communities, potentially leading to statewide spread.

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Partnership Advances a Revolution in Mental Health Care

The author, Diane Powers, in Idaho in 2013, during a series of site visits in the Pacific Northwest to determine grant awards.

The author, Diane Powers, in Idaho in 2013, during a series of site visits in the Pacific Northwest to determine grant awards.

In 1998, a gallon of gas cost $1.15, the last episode of Seinfeld aired on TV, and the John A. Hartford Foundation quietly helped start a revolution in mental health care. That was the year Dr. Jürgen Unützer, then an early-career psychiatrist at UCLA, convinced the Hartford Foundation of the worthiness of a radical idea—bringing mental health care into primary care.

The idea of having a primary care provider treat patients for common mental health conditions was so different that Unützer and Wayne Katon, Unützer’s mentor and an established psychiatrist at the University of Washington, were having difficulty finding a funder to test it.

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On Each Other’s Team: What We Can Learn By Listening to Older Adults

poll_satisfaction350If our work at the John A. Hartford Foundation has taught us one thing, it’s this: In the quest to transform primary care for older adults, a huge part of the answer is deploying more geriatrically expert primary care teams that can coordinate and deliver care designed around the patient’s needs. You could call this the low-hanging fruit of health care reform, because, if there is a population in which we have the biggest opportunity to see improvements in both cost and quality of care outcomes, it is older Americans.

The debate on how best to deliver effective primary care has gone on a long time, sometimes frustratingly so, but it has almost never included a crucial constituency: older adults. Today we are pleased to help change that.

We believe that listening to older adults is essential if we are ever going to transform our primary care system so it can and does deliver well-coordinated, comprehensive, accessible care centered on their needs and goals. This belief has already led the Hartford Foundation to conduct two previous public opinion polls, focused exclusively on adults 65 and older, examining serious gaps in geriatric primary care and mental health care.

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Congrats to the Collaborative Pilot Grants Winners!

TS_200470127-001_winnersIt’s going to take all of us working together to make the changes we need to ensure that older Americans get the quality health care they deserve.

So I’m pleased to share the news that five winning teams have been selected to receive Collaborative Pilot Grants through a joint program between the John A. Hartford Foundation Centers of Excellence in Geriatric Medicine and Psychiatry and the Hartford Change AGEnts.

The five winning teams were chosen from 25 applications received from 15 centers, and were announced by the Hartford Foundation and the American Federation for Aging Research (AFAR).

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Content of Care and Patient Population Are Crucial in Evaluating Patient-Centered Medical Homes

TS_83405698_doctor300This 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.

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