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Learning Objectives
Describe the common goals of geriatrics models of care in the hospital and outpatient setting.
Understand how to prepare for a geriatrics practice model.
Describe how geriatrics models fit into the context of various payment mechanisms.
Describe the key components of hospital-based models and outpatient models of care.
Outline key strategies in sustaining and disseminating geriatrics models of care.
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Key Clinical Points
Multiple, evidence-based practice models are available to help interdisciplinary teams to improve care for populations of vulnerable older individuals.
Choosing the geriatrics model that best fits into your practice setting depends on the challenges that your team is trying to address, your ability to make the case for a change, and your skills to lead an interdisciplinary team toward improved care.
Measuring key outcomes at baseline and over time can assist the team in efforts to improve care.
Assessing the fidelity of the key components of the model intervention is important to implementing and sustaining geriatrics models of care.
Disseminating geriatrics models may require novel strategies to incorporate the key components of geriatrics models into the workflow and processes of routine care of older patients.
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Over the past four decades, geriatrics models of care have emerged to address the unique needs of older adults. These models deliver evidence-based practices to this growing segment of our population. Some of these programs have been evaluated in randomized clinical trials. Other models have been evaluated as quality improvement projects. Identifying the needs of vulnerable older adults as they receive health care will allow geriatrics leaders the opportunity to respond to our patients’ needs with programs that improve care. Geriatrics models of care use interdisciplinary approaches to address the needs of patients with multiple comorbid conditions. This chapter with describe models based in the hospital setting and in the outpatient setting. Approaches and models related to transitions in care are discussed in Chapter 18, Transitions of Care.
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Common goals of these geriatrics models of care include engaging patients and families in their plan of care, enabling patients to remain safely in the least restrictive site of care, and focusing on prevention strategies that optimize patients’ functional status and quality of life.
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Geriatrics models of care commonly address a specific population of older patients. Models can exemplify how hospitals and health systems fulfill their mission within their community. Geriatrics leaders commonly need to build a case for geriatrics models of care to fit with the hospital/health system priorities, emphasizing efforts to continuously improve care. Working with key stakeholders in health care organizations, geriatrics leaders seek to identify the resources that are available to support a new model, define where the model fits within other programs, and create a strategy to implement the model.
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A Background to Geriatric “Best Practice” Models
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Table 14-1 provides several ...