Successful Models of Comprehensive Care for Older Adults with Chronic Conditions: Evidence for the Institute of Medicine's “Retooling for an Aging America” Report
[see editorial comments by Dr. David B. Reuben, pp. 2348–2349]
Chad Boult MD, MPH, MBA
From the * Department of Health Policy and Management, Bloomberg School of Public Health, and † Department of Medicine, School of Medicine, the Johns Hopkins University, Baltimore, Maryland; and § Department of Family Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
Search for more papers by this authorAriel Frank Green MD, MPH
From the * Department of Health Policy and Management, Bloomberg School of Public Health, and † Department of Medicine, School of Medicine, the Johns Hopkins University, Baltimore, Maryland; and § Department of Family Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
Search for more papers by this authorLisa B. Boult MD, MPH, MA
From the * Department of Health Policy and Management, Bloomberg School of Public Health, and † Department of Medicine, School of Medicine, the Johns Hopkins University, Baltimore, Maryland; and § Department of Family Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
Search for more papers by this authorJames T. Pacala MD, MS
From the * Department of Health Policy and Management, Bloomberg School of Public Health, and † Department of Medicine, School of Medicine, the Johns Hopkins University, Baltimore, Maryland; and § Department of Family Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
Search for more papers by this authorClaire Snyder PhD
From the * Department of Health Policy and Management, Bloomberg School of Public Health, and † Department of Medicine, School of Medicine, the Johns Hopkins University, Baltimore, Maryland; and § Department of Family Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
Search for more papers by this authorBruce Leff MD
From the * Department of Health Policy and Management, Bloomberg School of Public Health, and † Department of Medicine, School of Medicine, the Johns Hopkins University, Baltimore, Maryland; and § Department of Family Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
Search for more papers by this authorChad Boult MD, MPH, MBA
From the * Department of Health Policy and Management, Bloomberg School of Public Health, and † Department of Medicine, School of Medicine, the Johns Hopkins University, Baltimore, Maryland; and § Department of Family Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
Search for more papers by this authorAriel Frank Green MD, MPH
From the * Department of Health Policy and Management, Bloomberg School of Public Health, and † Department of Medicine, School of Medicine, the Johns Hopkins University, Baltimore, Maryland; and § Department of Family Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
Search for more papers by this authorLisa B. Boult MD, MPH, MA
From the * Department of Health Policy and Management, Bloomberg School of Public Health, and † Department of Medicine, School of Medicine, the Johns Hopkins University, Baltimore, Maryland; and § Department of Family Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
Search for more papers by this authorJames T. Pacala MD, MS
From the * Department of Health Policy and Management, Bloomberg School of Public Health, and † Department of Medicine, School of Medicine, the Johns Hopkins University, Baltimore, Maryland; and § Department of Family Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
Search for more papers by this authorClaire Snyder PhD
From the * Department of Health Policy and Management, Bloomberg School of Public Health, and † Department of Medicine, School of Medicine, the Johns Hopkins University, Baltimore, Maryland; and § Department of Family Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
Search for more papers by this authorBruce Leff MD
From the * Department of Health Policy and Management, Bloomberg School of Public Health, and † Department of Medicine, School of Medicine, the Johns Hopkins University, Baltimore, Maryland; and § Department of Family Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
Search for more papers by this authorAbstract
The quality of chronic care in America is low, and the cost is high. To help inform efforts to overhaul the ailing U.S. healthcare system, including those related to the “medical home,” models of comprehensive health care that have shown the potential to improve the quality, efficiency, or health-related outcomes of care for chronically ill older persons were identified. Using multiple indexing terms, the MEDLINE database was searched for articles published in English between January 1, 1987, and May 30, 2008, that reported statistically significant positive outcomes from high-quality research on models of comprehensive health care for older persons with chronic conditions. Each selected study addressed a model of comprehensive health care; was a meta-analysis, systematic review, or trial with an equivalent concurrent control group; included an adequate number of representative, chronically ill participants aged 65 and older; used valid measures; used reliable methods of data collection; analyzed data rigorously; and reported significantly positive effects on the quality, efficiency, or health-related outcomes of care. Of 2,714 identified articles, 123 (4.5%) met these criteria. Fifteen models have improved at least one outcome: interdisciplinary primary care (1), models that supplement primary care (8), transitional care (1), models of acute care in patients' homes (2), nurse–physician teams for residents of nursing homes (1), and models of comprehensive care in hospitals (2). Policy makers and healthcare leaders should consider including these 15 models of health care in plans to reform the U.S. healthcare system. The Centers for Medicare and Medicaid Services would need new statutory flexibility to pay for care by the nurses, social workers, pharmacists, and physicians who staff these promising models.
Supporting Information
Supplement, Tables S1–S15
Appendix S1. Each row of each table summarizes one high-quality study of a “successful” model of care. For each model, the columns on the left provide information about the relevant published research. The columns on the right summarize the findings of the research. Outcomes that were statistically significantly better for the recipients of the studied model than for the comparison group are displayed in green. Increases in the use of services and cost of health care (sometimes desirable) are displayed in red. Bolded entries indicate meta-analyses.
Table S1. Evidence About the Effects of Successful Interdisciplinary Primary Care Models
Table S2. Evidence About the Effects of Care and Case Management
Table S3. Evidence About the Effects of Disease Management.
Table S4. Evidence About the Effects of Preventive Home Visits
Table S5. Evidence About the Effects of Outpatient Comprehensive Geriatric Assessment (CGA) and Geriatric Evaluation and Management (GEM)
Table S6. Evidence About the Effects of Pharmaceutical Care
Table S7. Evidence About the Effects of Chronic Disease Self-Management (CDSM)
Table S8. Evidence About the Effects of Proactive Rehabilitation
Table S9. Evidence About the Effects of Caregiver Education and Support on Care Recipients
Table S10. Evidence About the Effects of Transitional Care
Table S11. Evidence About the Effects of “Substitutive” Hospital-at-Home
Table S12. Evidence About the Effects of “Early Discharge” Hospital-at-Home
Table S13. Evidence About the Effects of Models of Care in Nursing Homes
Table S14. Evidence About the Effects of Prevention and Management of Delirium
Table S15. Evidence About the Effects of Models of Comprehensive Inpatient Care
Please note: Wiley-Blackwell is not responsible for the content or functionality of any supporting materials supplied by the authors. Any queries (other than missing material) should be directed to the corresponding author for the article.
| Filename | Description |
|---|---|
| JGS_2571_sm_suppltables.doc360.5 KB | Supporting info item |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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