Implementing Models of Geriatric Care—Behind the Scenes

Abstract

Innovative geriatric clinical programs have proliferated in the 21st century, and many have been highlighted in the Journal of the American Geriatrics Society (JAGS). The Affordable Care Act has supported the accelerated innovation of publicized and unpublicized program development, adaptation, and implementation. Many JAGS articles report work conducted in programs with significant improvements in quality; high satisfaction for patients and providers; and for some, reductions in costs. Despite considerable detail, enabling implementers to attempt to adopt reported programs or adapt them to local environments, much less is typically conveyed about the subtleties of the implementation process that led to a successful outcome. Moreover, where we have been given a window into successful initiatives, far less is known about those that failed and even less about why some succeeded but others failed. With a focus on our shared needs as a geriatrics community, to foster the exchange of more-comprehensive models of successful and failed implementation, we propose publications that address implementation itself-a second layer of reporting about the "hidden" elements that may have been decisive factors in taking an efficacious test, treatment, or model and putting it into real-world practice. We propose a new platform for sharing a broader range of healthcare quality improvement initiatives-successes and failures. We include several salient characteristics that could be measured and described in support of dynamic, sustainable, evidence-based implementation of geriatrics programs.

An interdisciplinary statement of scientific societies for the advancement of delirium care across Europe (EDA, EANS, EUGMS, COTEC, IPTOP/WCPT)

“…This comprehensive assessment leads to a coordinated and integrated plan for treatment and follow-up [39]. However, it has been recently reported that the implementation of multifaceted and interdisciplinary interventions might indeed be challenging and it is necessary to better describe, disseminate and expand evidence-based geriatric models [40].…”

Evaluation of a Multicomponent Care Transitions Program for High‐Risk Hospitalized Older Adults

“…Our implementation of the STAR program in a community teaching hospital was not effective in reducing hospital readmissions or return ED visits within 7 and 30 days of hospitalization. Although we did not implement our program as a randomized controlled trial, we used several basic principles of implementation science and implementing models of care in the geriatric population . We also used propensity score matching that allowed us to compare similar patients in the STAR and comparison groups.…”

“…Although we did not implement our program as a randomized controlled trial, we used several basic principles of implementation science and implementing models of care in the geriatric population. 33,34 We also used propensity score matching that allowed us to compare similar patients in the STAR and comparison groups. However, if patients admitted to the STAR program had greater severity on unobserved clinical factors relative to the comparison groups, this could have influenced our results.…”

“…24 Our experience in implementing the STAR program was similar to our randomized trial of INTERACT implementation, 23,39 and to other studies that highlight the need for strong leadership buy-in to motivate robust and consistent intervention implementation. 33,34,40,41 The motivation in our local environment in terms of financial incentives was in fact not strong at the time of this project because of the relatively low penetration of value-based reimbursement programs, and neither the hospital nor local PAC organizations were at risk for substantial financial penalties based on readmission rates.…”

The Importance of Geriatric Care Models

“…Many healthcare organizations are struggling to develop risk-based population health management strategies. Geriatric care models are focused on high-risk, high-need patients and can be valuable resources for healthcare organizations [4,5].…”