The Department of Veterans Affairs sponsored half of the three dozen organizations; hospices represented another third, while the remainder were integrated delivery care systems, home-care agencies, or managed care organizations. The Institute for Healthcare Improvement also cosponsored the nine-month endeavor.
The collaborative had several goals, primarily to improve patient care while helping patients retain some quality of life despite the implications of living with an unpredictable yet fatal disease. Each of the 35 teams came up with ways to meet patient needs for individualized care that address the underlying disease, as well as the psychosocial aspects of living with such disease.
Team presentations demonstrated the various methods used to implement the goals of the collaborative. For instance, representatives from the Northport, NY, Veterans Affairs Medical Center described how they had used multidisciplinary case management for CHF patients as a way to address medical issues, improve patient compliance, help with transportation to and from visits, and work with exercise physiologists and nutritionists to help patients. The team described how it had developed a relationship with a skilled nursing care agency to provide care in patients’ home.
The team helped alleviate patient anxiety, a common symptom for patients with dyspnea, by reviewing with patients instructions on calling for help and by giving patients a contact list. The team addressed palliative care planning by reviewing patents’ understanding of their prognosis, and creating a palliative care checklist to cover most eventualities at the end of life. With patients and families, the team worked to identify problematic symptoms and develop a care plan.
Team member William S. Zirker, M.D., Chief of Geriatric Medicine at the Northport VA, presented promising results: the rates of advance care planning jumped from approximately 10 percent to 90 percent - in only four months! - while keeping rates of disease exacerbation low. The team’s message echoed those of their colleagues: despite barriers to genuine comprehensive care, the patients who are being served need it, and they benefit from the development of new models of care to serve their needs.
Dr. Adler, a fellow in the Division of Geriatric Medicine and Gerontology at Emory University in Atlanta can be reached at ladler@emory.edu.
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