This chapter addresses the following Geriatric Fellowship Curriculum Milestones: #8, #16, #25
Identify differences between multidisciplinary, interdisciplinary, and transdisciplinary teams.
Describe the roles of at least four different disciplines on care teams.
List at least two positive outcomes from geriatric team care.
Key Clinical Points
Team-based geriatric care is critical to the delivery of comprehensive, coordinated health care to older adults, their families, and caregivers.
Several evidence-based models for team-based care exist that may be useful for organizations wanting to develop training programs for geriatric team-based care.
Each discipline must clearly understand the unique role and function of other disciplines on the team.
Geriatric interprofessional team (IPT) care (also referred to as interdisciplinary team care) is essential to providing effective care for complicated older adults with multiple comorbidities. Research has demonstrated that IPT care is associated with enhanced functional and cognitive status, reduced depression and other psychological symptoms, and improved subjective well-being. Geriatric IPT care has also been shown to reduce hospital readmissions and outpatient service use. Specialized IPTs focusing on specific diseases such as congestive heart failure, stroke, myocardial infarction, or dementia have also demonstrated improved patient outcomes.
The current and projected health care workforce shortage, coupled with the aging of the population, dictate that care models be as efficient and effective as possible. Increasing numbers of frail, older adults with complex needs demand widespread adoption of geriatric IPTs. In this chapter, key components and benefits of geriatric IPT care are described along with the patient-centered IPT model, currently recognized as the standard of care.
BACKGROUND AND RECENT EVIDENCE FOR EFFECTIVENESS OF TEAM CARE
In the landmark report, Crossing the Quality Chasm, the Institute of Medicine (IOM) strongly urged that all health professionals receive interdisciplinary team training to ensure the delivery of patient-centered care. More recently, additional IOM reports specifically point to the need for interprofessional care for geriatric patients. For example, Retooling for an Aging America (2008) and The Future of Nursing: Leading Change, Advancing Health (2010), describe workforce requirements necessary for a health care system that will adequately meet the needs of older adults. Anticipating a shift toward population-based care, increasing the use of technology and bundled payment models such as accountable care organizations (ACOs), the reports include an emphasis on what has now become known as the triple aim: better health, better care, and lower costs. The Joint Commission (TJC) has stated that shared decision making and an interprofessional health care team approach are essential to reduce medical errors and to provide improved patient safety in all health care organizations in America.
Reports from the Josiah Macy Jr. Foundation specifically point to the need for IPT care for geriatric patients. These reports emphasize the urgency of creating culture change around partnering with the patient ...