Health AGEnda

Health Services Research Needs Good Theory to Turn into Better Practice

HospitalOlderWoman_400pLast 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.

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Reflections on a Summer at the Hartford Foundation

Before starting my internship with the John A. Hartford Foundation, the notion of improving health outcomes while decreasing costs appeared implausible. Securing strong patient-centered care for a loved one had to come at an extra expense—a large price tag for both the individual, his family, and the institution administering the care. After all, my family recently hired a home health aide to assist and advocate for my grandfather during his stay in the hospital and then during hospice, what is supposed to be one of the most patient-centered forms of care. My family believed that a consistent, if costly, presence and support system would serve him well during employee shifts and other downtime between caregivers.

And it made a difference. Our aide, Abdulai (last name withheld), served as my family’s lifeline, the person my grandfather could rely on for personalized and direct care, the person my mother could trust in clarifying medications and complicated procedures.

Author Caitlin Brookner (back, left) with her cousins and grandfather.

Author Caitlin Brookner (back, left) with her cousins and grandfather, Leonard Weisberg.

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The 2013 Hartford Foundation Annual Report
Part II: The Power of Partnerships

This is the second in a three-part Health AGEnda series on the Hartford Foundation’s 2013 Annual Report: Spreading Innovation Through Collaboration.

JAHFAR13_cover_300Although he was a star in a different field, something basketball legend Michael Jordan once said applies equally to the work of the John A. Hartford Foundation: “Talent wins games, but teamwork and intelligence wins championships.”

Here at the Hartford Foundation, we see great merit in not only spurring innovations and winning each “game,” but also generating long-term champion partnerships that pave the road for meaningful and lasting change.

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Tools You Can Use: Geriatric Transitions Objective Structured Video Examination

Dr. Timothy W. Farrell, right, from the video series depicting a patient undergoing transitions of care across different locations of care.

Dr. Timothy W. Farrell, right, from the video series depicting a patient undergoing transitions of care across different locations of care.

It happens all too often: Older adults “fall through the cracks” of the health care system. They fall victim to bad transitions of care due to a host of issues, including poor communication, a lack of geriatrics expertise on the part of the health care provider, and a dysfunctional or non-existent team.

As a result, older adults are rehospitalized, frequently move across sites of care, and receive suboptimal and, too often, harmful services.

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Short and Sweet Video Messages Help Tell Hartford’s Story

HartAR12_logo300Our most recent annual report celebrated the John A. Hartford Foundation’s 30-year commitment to improving the health of older adults. As part of the online, interactive version of the report, we asked some of our long-time grantees to help us tell the Foundation’s story by sharing short and sweet video messages about our past successes, our current projects, and our new directions.

We want to highlight a few of these brief video clips, each only about one minute long, and invite you to browse and share the other messages in our dynamic online annual report.

In this first video, David Reuben, director of the Multicampus Program in Geriatric Medicine and Gerontology and director of the Hartford Center of Excellence in Geriatric Medicine at UCLA, points out the changes he’s seen over the past three decades in how geriatrics is incorporated into medical student education. Dr. Reuben was a beneficiary of the 1983 Hartford Geriatrics Faculty Development Awards, Hartford’s earliest program to build up the field of geriatrics.

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New CMS Code Offers Hope for Radical Transformation of Primary Care for Older Adults

While still shrouded in mist, the path to transforming our health care system is becoming more clear.

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.

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What the Heck Are Hartford’s New Funding Areas? Part Five: Public Policy and Communications

TS_76744668_umbrella300What is the best way to sell umbrellas? We have tons of street vendors in New York who know the secret. Is it to have the best-made, reasonably priced umbrella on the block? That’s a good starting point.

Do you need an attractive sign or an attention-getting catchphrase? Good advertising certainly helps. But if you really want to sell your umbrellas, there is one sure-fire way to have them fly off your cart. You guessed it.

Make it rain.

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What the Heck Are Hartford’s New Funding Areas? Part Three: Models of Care

Jürgen Unützer, MD, brings the IMPACT model of depression care to Casper, Wy.

Jürgen Unützer, MD, brings the IMPACT model of depression care to Casper, Wy.

Given the John A. Hartford Foundation’s  focus on improving the health of older Americans, it should come as no surprise that the Foundation has looked for opportunities to create a more comprehensive, coordinated and continuous health care delivery system.

Since the 1990s, we’ve done this by investing in the development, testing, and spread of effective and affordable Models of Care to address barriers to the provision of high-quality, cost-effective care for elders.

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The Hospital Readmissions Debate: A Primer

TS_200314219-001_Hospital300In recent months, the debate over how best to reduce avoidable hospital readmissions has become a hot topic in the national media. While many are just now joining the fray, the John A. Hartford Foundation has been working on this issue for years.

Hartford grantees have developed evidence-based models that are now in the forefront of the national debate, including Eric Coleman’s Care Transitions Intervention, Mary Naylor’s Transitional Care Model, and the Society of Hospital Medicine’s Project BOOST.

It also has been a topic we have written about extensively on our Health AGEnda blog as we seek to help shape the public debate about an issue that is at the very core of real and sustainable health care reform and of critical importance to older adults.

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Medicare readmissions reduction reform is complex, scary—and absolutely necessary

NHPFlogo250Last Friday I was at a session of the National Health Policy Forum (NHPF) in Washington D.C. focused on Medicare’s readmission reduction program  The program, authorized under section 3025 of the Patient Protection and Affordable Care Act (PPACA), is the “stick” to section 3026’s “carrot.”

Section 3026 authorizes the $500 million Community-based Care Transitions Program that will pay partnerships of community-based organizations and hospitals to offer evidence-based, post-discharge services to reduce readmissions. Section 3025, in effect since October 2012, dropped the other shoe and requires the Centers for Medicare and Medicaid Services (CMS) to reduce payment for Medicare services to hospitals whose patients have higher than expected rates of rehospitalization within 30 days of discharge. (For more background, watch this Modern Health interview  with longtime John A. Hartford Foundation grantee Eric Coleman, MD, read this recent Reuters article featuring Coleman, and this post I wrote on Health AGEna in December 2010.

Clearly the audience at the session was very concerned about the program and seemed sure that it should changed, if not abandoned (See my response to a Wall Street Journal op-ed last month.). I see the matter very differently and I’d like to explain why. NHPF Sessions are off the record, so I won’t use any quotes or attribution.

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