Key Elements of High-Quality Primary Care for Vulnerable Elders

Abstract

With the impending surge in the number of older adults, primary care clinicians will increasingly need to manage the care of vulnerable elders. Caring for vulnerable elders is complex because of their wide range of health goals and the interdependence of medical care and community supports needed to achieve those goals. In this article, we identify ways a primary care practice can reorganize to improve the care of vulnerable elders. We begin by identifying important outcomes for vulnerable elders and three key processes of care (communication, developing a personal care plan for each patient, and care coordination) needed to achieve these outcomes. We then describe two delivery models of primary care for vulnerable elders -co-management, and augmented primary care. Finally, we discuss how the physical plant, people, workflow management, and community linkages in a primary care practice can be restructured to better serve these patients.KEY WORDS: primary care; practice redesign; quality of care; quality improvement; older adults.

Capsule Commentary on Bennett et al., Engaging Stakeholders to Inform Clinical Practice Guidelines that Address Multiple Chronic Conditions

“…Some of these structural aspects of care were considered key elements of high-quality primary care for vulnerable elders in previous research. 3 This approach supports the notion that focusing on patients' priorities and making decisions based on patients' views, not on diseases, is possible 4 not only in clinical settings, but also in the translation of evidence-based medicine to the care of people with MCC. 5 With this study, the authors have opened the door to new evidence perspectives in the field of MCC care by including patients' perceptions in the methodology of developing CPGs.…”

Healthcare provider perceptions of accessible exam tables in primary care: Implementation and benefits to patients with and without disabilities

“…These findings align with previous research which suggests that accessible examination tables are beneficial to patient care across many patient populations other than just PWD. [19][20][21] Despite the benefits, providers discussed several relevant challenges to routine use of the height-adjustable tables. First, multiple providers noted that unless the patient's chief complaint necessitates evaluation on a table, the provider will not use it.…”

Frailty and perioperative outcomes: a narrative review

“…In this model, there are three core realms to improve these outcomes: communication between the patient and caregiver, a personal care plan, and coordination of care between healthcare providers. 48 A co-management model where all providers of healthcare share responsibilities is useful for managing the frail patient who has undergone a major surgical stressor. This necessitates sufficient access to other clinical experts, such as geriatricians, rehabilitation therapists, nurse specialists, and case managers, while establishing links to the community.…”

“…This necessitates sufficient access to other clinical experts, such as geriatricians, rehabilitation therapists, nurse specialists, and case managers, while establishing links to the community. 48 …”