This is the second in a two-part series. To read the first part, click here.
This is the second in a two-part series. To read the first part, click here.
This is the first in a two-part series. To read the second part, click here.
Altarum Institute has released a report that highlights the Practice Change Fellows Program’s successful efforts to develop change leaders who spread innovations that improve the health of older adults.
The Supreme Court’s recent ruling in favor of requiring all American citizens to have health insurance coverage has eliminated much uncertainty over who will have access to health care, but it has not prepared us for a crisis over the availability and cost of health care that is just about to hit. In fact, some would argue that this crisis is already upon us. FACT: Every day, 10,000 Boomers turn 65, a trend that will continue for the next 18 years—and most of them will live to a ripe old age.
Your 80-year-old mother, who can’t recognize you due to severe Alzheimer’s dementia, has developed pneumonia after being hospitalized with a broken hip. Her doctor has told you that she might pull through and that the medical team needs your input on how and where she will live after this episode: at home, or at a nursing home, and with what help—family, home care agency, and/or hospice. You realize that you don’t know what her wishes are—and that she can no longer express them.
Readers of this blog are familiar with—and mostly supportive of—these two claims: (1) that social and environmental factors are stronger than health care services in shaping the population’s health, but (2) those factors are weaker than health care services in securing funding and public attention. Most of us are convinced that sending more funds and public support toward healthy food and exercise would do more to improve health than sending those funds toward high-cost medications or surgeries,
The goal of a more effective and efficient system of care is straightforward—better care at lower costs. The path to that goal has proven far more elusive. To meet these aims, we must focus on those who really need the system to perform better—people with advanced illness and functional limitation. We must speak with them on their terms and build plans of care that appreciate them as people, not just as patients.
According to the Institute of Medicine’s Preventing Medication Errors report, the average hospitalized patient encounters at least one medication error per day. One in five errors harms the patient. More than 40 percent of medication errors arise during care transitions (admissions, transfers, and discharges from one setting to another) when various possible medication lists are not brought together in a process called reconciliation.
A few days into my 68-year old father’s hospitalization for sepsis, his doctors determined the strain of bacteria that plagued him: streptococcus. My sister was there when they came in with this part of the diagnosis; she has a doctorate in engineering with a focus on the human heart (that engineering marvel), and she likes details.
“What strain?” she asked the doctor. “A, B, or C?”
His reply: “What does it matter to you?”
Although not an easy discussion, it is vital that we know the preferences and choices of loved ones (and they know ours) regarding the kind of support you and those you love expect long before a crisis occurs.