Tuesday, April 24, 2012

It's Team Based Care, Not More Experts!

Oh oh. 

A nurse asks about falls
Another study  that shows how awful physicians are ("Doctors Fall Short") and, according to the press release, "why expert geriatric care is needed." 

According to the John A. Harford Foundation, a poll of over a thousand elders revealed that physicians aren't performing an annual review of their medications, asking them whether they're prone to falling, screening them for the presence of depression, providing them with referrals to community-based health resources or assessing their ability to perform activities of daily living (ADLs).  The depressing poll results are here.  Combine these data with this infamous 2003 NEJM study and it's easy to conclude that primary care quality is declining faster than a U.S. secret service agent can say "let's party!"

The contrarian Disease Management Care Blog is:

1. Unsurprised that, once again, disconnected academics who know little about the realities of clinical medicine failed to appreciate what the literature is also telling us: the provision of all recommended care services to all eligible patients seen in the course of a typical clinic day would crowd out everything else.  Real world clinical medicine is the art of priorities and compromises.

2. Disappointed that the sophisticated Hartford Foundation staff would be stuck on a physician-centric notion that "expert geriatric care" is the answer to a systems failure.  Hogwash: assessing medications, screening for falls, depression, ADL limitations and referring to community resources doesn't take expertise.  It takes team-enabled primary care that includes nurse-led population health management. 

Too bad the Hartford didn't ask the survey respondents about that option and/or submit their report for peer-reviewed publication; if they had, the reviewers could have turned this second rate press release into something with greater discipline.

3. Hopeful that this survey, as bad as it is, will prompt others to recognize what DMCB readers already know: geriatric screening and prevention can be practically "outsourced" to non-physicians who, in turn, can use the principles of population health management with information technology (such as links, protocols and standing orders) to get the right care to the right patients at the right time.

You'll be able to learn more about this if you listen in on this upcoming webcast.

1 comment:

Bradley Dean Stephan said...

Great commentary – but the $64K question is where's the financial incentive to provide these population health management services? If Obamacare (ok, this term is no longer a pejorative) is overturned, then it's back to "long live FFS!" - where the reward is to replace the hip, rather than prevent the trip.