Getting Past the Complexity

Janice Simmons, for HealthLeaders Magazine , June 9, 2010
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When Med-IC, working with a grant from Atlantic Philanthropies, decided to form a collaborative, it received 20 applications from organizations—each with a record of good geriatric care, Siu says. The goal was that each site test one or more innovative programs designed to improve care for its Medicare patients with multiple chronic conditions.

Senior patients with challenging conditions are making up an increasingly significant portion of the hospital population, Siu says, and their care is complex and expensive. The six sites are serving as "learning laboratories." Aside from Hospital at Home, ACE, and palliative care, the other models include:

  • NICHE (Nurses Improving Care to Healthsystem Elders), a program providing clinical and organizational tools for improving hospital care of older adult patients, with oversight by a nursing team.
  • HELP (Hospital Elder Life Program), designed to prevent delirium among hospitalized older patients using trained volunteers and skilled interdisciplinary staff.
  • Care Transitions Intervention, a program for patients with complex care needs and family caregivers that helps them learn self-management skills and meets their needs during the transition from hospital to home.

While Med-IC is supplying ongoing consultative support, the sites are mostly paying for their own costs related to the collaborative program. The leaders in the collaborative organizations are those who saw "that you couldn't run away from Medicare"—which now accounts for 37% of hospital admissions and 50% of hospital bed days, Siu says. "Medicare will become a part of hospitals' businesses, and hospitals need to learn better ways of managing this population without losing their shirts."

One of those hospitals taking up the challenged is the 457-bed Carolinas Medical Center/Mercy. Prior to the collaborative, the medical center only had a palliative care model. It is looking to test all of the models during the year—and eventually disseminate its findings to others in the 30-hospital Carolinas HealthCare System.

CMC/Mercy saw this as a chance "to learn more about how to develop a senior service line" that was part of a strategic business plan created three years ago, says Phyllis Wingate Jones, the medical center's president. "We saw it as a real opportunity, particularly for a community hospital, to do more to in terms of providing a continuum of services to seniors and to do that in a quality manner," she adds.

Meanwhile, Aurora Health Care, a Milwaukee-based integrated healthcare system, is looking to expand its ACE program for cardiac patients—such as through the e-Geriatrician program, which helps geriatricians perform "virtual rounds" via telemedicine, says Michael Malone, MD, medical director of Aurora's senior services.

Aurora is also looking to expand palliative care, with healthcare professionals who see older patients working with palliative care experts to improve the "ability to use palliative care principles in daily care," Malone says. "We posed that primary care providers should be stepping forward to help patients and their families with their skills—instead of taking a step backward and letting someone who doesn't even know the person address those needs."

Janice Simmons is senior quality editor for HealthLeaders Media. She may be contacted at

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