Doctors in the House
For elderly patients, health care at home is often best, says geriatrician Bruce Leff.
Judy F. Minkove
Date: February 18, 2011
Bruce Leff has never been shy about advocating for better care for older adults. A driving force behind the Johns Hopkins Elder House Care Program, the Hopkins geriatrician was recently appointed to the U.S. Health and Aging Policy Fellows Program to work on public policies affecting older Americans. Leff will focus on implementing the Independence at Home Act that was part of the recently passed health care reform legislation.
One national program that’s gained traction, which Leff is co-piloting, is the Medicare Innovations Collaborative (Med-IC). The program’s goal: to improve the quality of life for hospitalized elderly patients and help hospitals’ bottom line.
Leff and his colleague Albert Siu, professor of geriatrics at Mount Sinai School of Medicine, are co-principal investigators for Med-IC, which shares best practices for improving hospital-based geriatric care. Ideally, says Leff, that means managing patients with chronic illnesses in an outpatient setting for as long as possible. But when acute flare-ups require hospitalization, these patients would be managed humanely and efficiently so that they could return home faster.
“We want to change how services get deployed,” says Leff. “We need to deliver care to people in their homes to avoid the nastiness of hospitals. When these patients do need to be admitted, every effort should be made to get them through that experience safely and efficiently and, at discharge, to keep them from being readmitted.”
Leff’s research has found that patients with multi-morbid conditions who are admitted to hospitals typically experience complications from inappropriately prescribed medications, suffer from preventable medical errors, and go home lacking the information and follow-up they need. As a result, one in 10 is readmitted to a hospital within 15 days, and one in five is back at the hospital within 30 days.
Three years ago, Siu and Leff received a grant from The Atlantic Philanthropies to develop a business case giving hospitals the tools—evidence-based practices—to help them provide the best possible care to older adults. Med-IC evolved from there.
Med-IC selected six sites with a proven track record for excellent geriatric care to act as “learning laboratories” to test the feasibility of offering novel programs that would incorporate a “geriatric portfolio” care model. This includes using established geriatric assessment tools and quality improvement; palliative care; a national program to improve elder care and nurse competence; strong transitional care; and Hospital at Home, a project Leff designed that provides hospital-level care in a patient’s home to substitute for acute hospital care.
Med-IC has had ongoing collaboration with policymakers, government officials, hospital administrators, researchers, and organizations with ties to older adults. “Over time,” says Leff, “we can see an effect. If we have 20 to 50 programs in a climate of health care reform, we can really get it moving.”