Browsing by Subject "models of care"

Now showing 1 - 2 of 2
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    Caught in a Loop with Advance Care Planning and Advance Directives: How to Move Forward?
    (Mary Ann Liebert, Inc., 2022-03) Periyakoil, Vyjeyanthi S.; von Gunten, Charles F.; Arnold, Robert; Hickman, Susan; Morrison, Sean; Sudore, Rebecca; Medicine, School of Medicine
    Completion of an advance care planning (ACP) process and/or an advance directive should result in patients receiving the care they desire at the end of life. However, three decades of research have shown that is just not the case. ACP has been a front runner in developing the science within palliative care. Some positive outcomes such as lowering levels of surrogate grief may be associated with ACP. Yet, it does not appear that further ACP research will ensure that seriously ill patients will get goal-concordant care. An unfortunate consequence of palliative care research and advocacy so far is the misguided notion of many hospital systems trying to solve their palliative care problems by only implementing an ACP initiative. At best, ACP is but one tool in the collective palliative care toolbox. New tools are needed. Given that we have finite resources, future research should focus more on tools to improve symptom management, better models of care, and systems that will ensure goal-concordant care that meet the needs of the population that the health care system is designed to meet.
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    Implementing Models of Geriatric Care—Behind the Scenes
    (Wiley, 2018) Chodosh, Joshua; Weiner, Michael; Medicine, School of Medicine
    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.