Care Delivery:
Perhaps the most significant and representative research project to improve the care of the elderly has been demonstrated with "Community Centers of Excellence for the Aging. " (CCEA) Since 1993, the John A. Hartford Foundation has supported this project and its successors to create better partnerships between patients and their doctors by enhancing better communication, educating patients about their health, increasing physician awareness about health needs of their patients and responding to unmet needs... ultimately improving the quality of life for the elderly. Using the Dartmouth COOP Clinical Improvement System as well as the "Improve Your Medical Care" questionnaire the intervention has yielded positive results. Eighty percent of patients believe that the quality improvement approach has improved their health, and that their clinicians have become more aware of important and otherwise unmet patient needs. More patients are aware of preventive measures, such as flu shots, and many patients now have advance care plans. There is improved knowledge about home health hazards and about the importance of keeping track of medication. Patients who have begun to exercise say that they feel much better.
The project is now in its second phase, and versions have been designed specifically for Spanish speaking and disadvantaged elderly patients. These models are currently being disseminated in federally funded Community Health Centers in Maryland, Pennsylvania, Texas, Iowa, and California. This effort has been sponsored by the John Hartford Foundation of New York City.
Hitchcock 80+ Project: In the fall of 1996, the Hitchcock Clinic and the CFA agreed to work together over the next years to improve the care of persons 80 years of age or older. Although these persons constitute only 22% of the Medicare population, they account for 35% of its costs. The cost of care of this age group shows three times as much variation as that provided to younger Medicare beneficiaries. Many of these persons express a preference for care and comfort if they become seriously ill, whereas current Medicare payment patterns encourage the provision of acute care services. More than the 1,000 physicians who provide care in the Dartmouth-Hitchcock health care system are increasingly under pressure to improve the value of care they provide to the elderly. Because of the associated risks, costs and variation of their medical care, 80+ patients are sentinel for elder care quality within DHMC. The entire Journal of Ambulatory Care Management, scheduled for the Summer of 1988, will be devoted to this topic. In addition, the Institute for Healthcare Improvement (IHI) will use the CFA's 80+ project as a program for national dissemination in the Spring of 1998.
Other clinical improvement projects include:
- Flu Shot and Elderly Assessment Program - to heighten physician awareness of patient needs and improve patient awareness of health issues and common problems of the elderly
- In collaboration with the COOP, the CFA is developing and evaluating systems for enhancing the physician-patient and physician-nurse communication to improve elderly patient care and satisfaction. These can be used in any of the six model clinics (Paul Model Clinics).