Bridging the gaps in care: The importance of older adults’ transitions across health care settings

7/26/2019 Bridging the gaps in care: The importance of older adults transitions across health care settings

1/37


2/37

Objec"i(e!

2

I&e#"i%* c'alle#)e! 'eal"'care5r$(i&er!, $l&er a&-l"!, a#& care)i(er!%ace &-ri#) care "ra#!i"i$#!

Rec$)#i6e "'e i+5ac" $% e7ec"i(e"ra#!i"i$#! $% care $# i+5r$(i#) 'eal"'$-"c$+e! a#& re&-ci#) 'eal"'carec$!"!

Di!c-!! "'e i#8-e#ce $% #ei)'b$r'$$&!

a#& c$++-#i"* $# care "ra#!i"i$#!a%e"* a#& 9'a" 5e$5le ca# &$ "$ )e""'e be!" 'eal"'care 5$!!ible


3/37

3

.'a" &$ "'e!ei+a)e! 'a(e i#c$++$#


4/37

T'e S"$r* $% .al"er Al"+a#

;< *ear $l& 9i&$9er

Re"ire& "eac'er, li(e!al$#e

I#c$+e: !+all 5e#!i$#Da-)'"er li(e! 03

+ile! a9a*, 'a!"'ree "ee#a)er!

i(e c'r$#ic c$#&i"i$#!T'ree 5'*!icia#!

Ei)'" +e&ica"i$#!

4


5/37

I# "'e 5a!" *ear, .al"er 'a! 'a&=

6community

referrals

2'$+e carea)e#cie!

5months

homecare

2nursing

homes

6weeks sub-

acute care

3hospital

admissions

19outpatient

visits

8meds

22scripts

S$cial .$r?er!, 1 P'*!ical T'era5i!"!, @ Occ-5a"i$#al T'er

5


6/37

.al"er

C$#%-!e& b* care, +e&!

Ge"! &i!c$-ra)e&

A&'ere#ce "$ care i! 5$$r

.al"er! &a-)'"erS"re!!e&

Re&-ce& 9$r? "$ 'al%"i+e

C$#!i&eri#) #-r!i#) '$+e!

6


7/37

Care Tra#!i"i$#! $-" $% "'e H$!5i"al.'a"i! "'e 5r$ble+, a#& 9'* care

C$++$#, c$+5lica"e&,a#& c$!"l*

Ol&er a&-l"! are5ar"ic-larl* (-l#erable

G$i#) '$+e 9i"' '$+e

care i! e!5eciall* ri!?*

7

C$le+a#, EA, e" alJ Am Geriatrics Soc. 233@


8/37

8

E#(ir$#+e#"

Emergency Department Visit

Inpatient Hospitalization

Hospital Ward Intensive Care UnitOperating Room

Silled

!"rsing

#acility

Home $%& Home Healt' Care (ong&)ermCare

#acility

*rimary CareSpecialists

Arbaje, AI.Tra#!i"i$#al Care Geriatrics Review Syllabus! A ore urriculum in Geriatric Medicine, "th ed.


9/37

Ol&er A&-l"! Tra#!i"i$# Pa""er#! i# "'eUS

1 in 4 transition

annually

1 in 3 transition 2+

times after discharge

Half of transitions are to

hospital and back

The rest are not easilypredictable

9

Sa"$, M, Arbaje, AI, e" al, Gerontologist 2303 02:0;3>C$le+a#, EA #ealth Serv Res 233


10/37

10

A($i&:I!$la"i$#

H$!5i"al!Me&ica"i$#!

T$$ +-c' 'eal"'

care

Researchers:Medical errors nowthird leadinca!se o" death in#nited $tates

Ma% 3, 2016


11/37

Tra#!i"i$#al Care

11

A !e" $% ac"i$#!&e!i)#e& "$ e#!-re "'ec$$r&i#a"i$# a#&

c$#"i#-i"* $% 'eal"'care a! 5a"ie#"!"ra#!%er be"9ee#&i7ere#" l$ca"i$#! $r

&i7ere#" le(el! $% care9i"'i# "'e !a+el$ca"i$#

C$le+a#, EAJ Am Geriatrics Soc.233 10@:1@


12/37

Arbaje, AI et al. Gerontologist 233> A-)F@>@:@


13/37

W'ere do older ad"lts live+


14/37

3 +i 233 @33 433>33 0333&o'%riht( and )*+ 19-2010 Microso"t &or'oration andor its s!''liers. All rihts reser/ed.htt':twww.icroso"t.coa''oinll

&ertain a''in and direction data ( 2010 A4. All rihts reser/ed. he ata "or areas o" &anada incl!des in"oration taen with 'erission "ro &anadiana!thorities. incl!din:( 8er Majest% the !een in Riht o" &anada. ( !eens *rinter "or ntario. A4 and A4 ;AR are tradears o" A4. ( 2010 ele Atlas orth

Aerica. Inc. All rihts reser/ed.ele Atlas and ele Atlas orth Aerica are tradears o" ele Atlas. Inc.( 2010 b% A''lied


15/37

3 +i 233 @33 433>33 0333

;1"'Perce#"ile Ab$(e 33>3

21;1"'Perce#"ile 33<

33>3

21"'Perce#"ile 32;

33;;1
http://www.microsoft.com/mappoinllhttp://www.microsoft.com/mappoinllhttp://www.microsoft.com/mappoinllhttp://www.microsoft.com/mappoinllhttp://www.microsoft.com/mappoinll


16/37

16

139'artici'ants62transitions

@2 5ar"ici5a#"!

1; 5ar"ici5a#"!

@3 5ar"ici5a#"!


17/37

Di)i"al Galler*17


18/37

1

$oe 'eo'le

will =nd this/er%

!nco"ortable.


19/37

Pr$(i&er! +$bile $Jce!

19 R!ral and $!b!rban $ites #rban $ites


20/37


21/37

>iited s'aces


22/37

I# T'eir O9# .$r&!=

KI& !a* ab$-" 13 $% "'e "i+e "'ere !ee+! "$ be!$+e"'i#) "'a" re-ire! a call "$ "'e &$c"$r "$ )e"!"rai)'"e#e& $-"

22

H$+e care #-r!e

22


23/37

KI% I &$#" 'a(e "'e c$rrec" i#%$r+a"i$#= !i+5le "'i#)! li?e ="'ea&&re!! i! c$+5le"el* 9r$#), "'e 5'$#e #-+ber i! 9r$#), "'e5'$#e #-+ber i! #$" i# !er(ice= "'e# I ca# !5e#& "'e &a*!5i##i#) 9'eel! calli#) 'ere a#& "'ere, calli#) e+er)e#c*

#-+ber! a#& "r*i#) "$ #& "'e 5a"ie#" '$+e care #-r!e


24/37

Grie%

-#c"i$#alI+5air+e#"

Deliri-+

N$+$#i"$ri#)

P$l*5'ar+ac*


25/37

U5r$$"e&, -#!e""le&, e+barra!!e&


26/37

Grie%

C$5i#)C$++-#i"*

a+il*


27/37

S"ar"i#) a#e9


28/37

2


29/37

Ob"ai#i#) "'e Be!" Heal"'careP$!!ible

I&e#"i%* a 'eal"'care a)e#"Ha(e $#e &$c"$r c$$r&i#a"e careD$ #$" )$ i" al$#eee5 5er!$#al 'eal"' rec$r&!Sc'e&-le 5eri$&ic +e&ica"i$# c'ec? -5!U!e $#e 5'ar+ac*

Crea"e e+er)e#c* 5la#! a#& rec$(er*!ce#ari$!

,-


30/37

C$++$# Pi"%all! "$ A($i&

M$re care Q be""er careM$re +e&ica"i$#! Q be""er

'eal"'A($i&i#) i+5$r"a#"

c$#(er!a"i$#!.'a" i% I )e" !ic?

.'a" i% +* 5ar"#er )e"! !ic?.'$ i! )$i#) "$ care %$r "'e+

.'$ i! )$i#) "$ care %$r +e

.'$ i! )$i#) "$ +a?e &eci!i$#!

%$r +e i% I ca#" +a?e "'e+ %$r

./


31/37

KA#* !*+5"$+ i# a# el&erl*5a"ie#" !'$-l& be c$#!i&ere& a

&r-) !i&e e7ec" -#"il 5r$(e#$"'er9i!e

.0

G-r9i"6 e" al 0


32/37

32

S"ra"e)* %$r 'eal"'* ea"i#)


33/37

33

9995cr+$r)999&r%-'r+a#
http://www.pcrm.org/http://www.drfuhrman.com/http://www.drfuhrman.com/http://www.pcrm.org/


34/37

3?

e


35/37

Real

GeriatriciansOF JOHNS HOPKINS

1

the


36/37

O#li#e Re!$-rce!

999'$5?i#!+e&ici#e$r)'eal"'*a)i#)

Mai#"ai# a 'eal"'* li%e!"*le %$r *$- a#& *$-r l$(e& $#e!9i"' i#%$r+a"i$# %r$+ /$'#! H$5?i#! e5er"!

999'eal"'i#a)i#)$r)Ti5! $# '$9 "$ +a#a)e 5r$ble+! "'a" $cc-r a! *$- )e"

$l&er

999#"$cc$r)

T$$l! %$r ?ee5i#) *$-r $9# rec$r&! 999a+erica#)eria"ric!$r)

H$9 "$ #& a )eria"ricia#

.1
http://www.hopkinsmedicine.org/healthyaginghttp://www.healthinaging.org/http://www.ntocc.org/http://www.americangeriatrics.org/http://www.americangeriatrics.org/http://www.ntocc.org/http://www.healthinaging.org/http://www.hopkinsmedicine.org/healthyaging


37/37

C$#"ac" I#%$r+a"i$#

Alicia I Arbaje, MD, MPH

C$##ec" 9i"' +e $#

999'$5?i#!+e&ici#e$r))eria"ric!

.2
http://www.hopkinsmedicine.org/geriatricshttp://www.hopkinsmedicine.org/geriatrics

Bridging the gaps in care: The importance of older adults’ transitions across health care settings

Documents

Transcript of Bridging the gaps in care: The importance of older adults’ transitions across health care settings