December 11, 2014

Care for Elderly Still a Problem

In several articles lately, the elderly have been shown to be on the short end and not receiving the care they may need. This is not a simple problem or a problem with easy answers. Report lead author Alicia I. Arbaje, M.D., M.P.H., director of transitional care research and assistant professor of medicine at Johns Hopkins Bayview Medical Center and the Johns Hopkins University School of Medicine said that what is believed to be the first interview-style qualitative study of its kind among health care providers in the trenches, displays very real problems.

A team led by a Johns Hopkins geriatrician has further documented barriers to better care of older adults as they are transferred from hospital to rehabilitation center to home, and too often back again. They used comments and concerns drawn from in-depth interviews of 18 physicians and two home health care agency administrators to create a framework for evaluating what actions and programs might improve care.

The research says:

  1. more attention should be given to preventing drug errors or missed doses of medicine
  2. earlier and more frequent communications among health care providers at different sites
  3. the elimination of discharge planning delays
  4. and patient education.

The Affordable Care Act of 2010 established a pay-for-performance financial incentive program to motivate better coordination. The study results suggest, however, that health care providers are unclear about how these incentives will be designed and are concerned that the wrong outcomes or processes will be measured.

Currently, health care providers have concerns about pay for performance that need to be considered. They desire a voice in the design process. Yea for them, but if this is the case, then patients should also have a voice as many health care providers do not have the desires and needs of the elderly patients in mind. The evidence of the current lack of concern by health care providers provides ample reason to include patients, patient advocates, and social workers in the mix of voices. This would be one way to avoid the same mistakes being currently carried on by our providers.

In their report on their work, “Excellence in Transitional Care of Older Adults and Pay-for-Performance: Perspectives of Health Care Professionals,” published in the December 2014 issue of The Joint Commission Journal on Quality and Patient Safety, the investigators note the persistent “mixed reviews” of the impact of tying compensation to quality of care. They also say that care transitions across health care settings remain “common, complicated, costly, and potentially hazardous for older adults.” As the ranks of older adults grow and their numerous illnesses require ever more drugs, specialists and facilities, poor transitional care frequently leads to re-hospitalizations and complications for patients.”
The research team uncovered three themes that addressed pay for performance:

  1. components and markers of effective care transitions,
  2. difficulties in design and implementation of pay-for-performance strategies,
  3. and unmet needs in delivering optimal care during transitions.

The research findings suggest ways to better define health care providers’ roles in care transitions:

  1. enhance communication,
  2. determine performance measurements,
  3. and improve education and training of providers.

Among the recommendations in the framework are calls for holding health care providers:

  • more accountable for patient education,
  • reimbursing providers for care coordination activities,
  • and providing training and hands-on experience for providers to facilitate care transitions.

Report lead author Arbaje explains that, “Health care providers may need additional training to better execute care transitions and to understand their role during transitions. Without this education, it is difficult to design pay-for-performance strategies with an end result of good patient care.”

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