scholarly journals Claims-Based Network Analysis of Disease Progressions in Complex and Non-Complex Older Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 672-673
Author(s):  
Peter Nicholas Onglao ◽  
Ciara Janer ◽  
Maria Eloisa Ventura ◽  
Lauren Bangerter
Keyword(s):  
Older Adults ◽  
Disease Progression ◽  
Disease Risk ◽  
Network Size ◽  
Social Needs ◽  
Multiple Chronic Conditions ◽  
Patient Centered ◽  
Complex Patient ◽  
Complex Patients ◽  
Progression Patterns

Abstract Older adults are the fastest growing subset of complex patients with high medical, behavioral, and social needs. Understanding differences in disease progression patterns between complex and non-complex older adults is critical for understanding disease risk and tailoring patient-centered interventions. We identified complex patients as those having frequent medical encounters and multiple chronic conditions within the first year of the study period and non-complex patients as the converse. This study compares the disease progression patterns of (a) complex and (b) non-complex older adults by creating disease progression networks (DPN) from claims data of 762,362 patients (mean age = 73) from 2016 to 2020. We characterized the network size and density between the complex patient DPN (C-DPN) and non-complex patient DPN (NC-DPN), and compared disease progression incidence, time-to-progression, and age- and gender-related risk. Results show that the C-DPN was denser and had a wider range of values for risk of progression compared to the NC-DPN. This implies more varied disease progression patterns occurring in the complex adults. We were also able to compare (median) time-to-progressions of diseases relative to each subpopulation and found variation in disease progression time. Furthermore, k-means clustering on the network allowed us to identify highly connected diseases involved in many disease pathways that are prevalent among older adults. (e.g., lipoprotein disorders, hypertension, major depressive disorder). Our results suggest that DPNs can be used to identify important conditions and time-points for tailoring care to the complex and non-complex older adults.

scholarly journals ‘Patient-Centered Care’ for Complex Patients with Type 2 Diabetes Mellitus–-Analysis of Two Cases

2013 ◽  
Vol 6 ◽  
pp. CMED.S12231 ◽  
Author(s):  
Jennifer M. Hackel
Keyword(s):  
Older Adults ◽  
Diabetes Management ◽  
Tight Control ◽  
Patient Centered ◽  
Treatment Approaches ◽  
Person Centered Care ◽  
Complex Patients ◽  
Centered Care ◽  
New Guidelines ◽  
Primary Care Practitioners

Purpose This paper serves to apply and compare aspects of person centered care and recent consensus guidelines to two cases of older adults with poorly controlled diabetes in the context of relatively similar multimorbidity. Methods After review of the literature regarding the shift from guidelines promoting tight control in diabetes management to individualized person centered care, as well as newer treatment approaches emerging in diabetes care, the newer guidelines and potential treatment approaches are applied to the cases. Results By delving into the clinical, behavioral, social, cultural and economic aspects of the two cases in applying the new guidelines, divergent care goals are reached for the cases. Conclusions Primary care practitioners must be vigilant in providing individualized diabetes treatment where multiple chronic illnesses increase the complexity of care. While two older adults with multimorbidity may appear at first to have similar care goals, their unique preferences and support systems, as well as their risks and benefits from tight control, must be carefully weighed in formulating the best approach. Newer pharmaceutical agents hold promise for improving the possibilities for better glycemic control with less self-care burden and risk of hypoglycemia.

Patient-Centered Care for Older Adults with Multiple Chronic Conditions: These are the Polypathological Patients!

2013 ◽  
Vol 61 (3) ◽  
pp. 475-476 ◽  
Author(s):  
Máximo Bernabeu-Wittel ◽  
Manuel Ollero-Baturone ◽  
Dolores Nieto-Martín ◽  
Salvador García-Morillo ◽  
Juan Goicoechea-Salazar
Keyword(s):  
Older Adults ◽  
Chronic Conditions ◽  
Patient Centered Care ◽  
Multiple Chronic Conditions ◽  
Patient Centered ◽  
Centered Care

scholarly journals PRESIDENTIAL SYMPOSIUM: OPTIMIZING SURGICAL CARE FOR ALL OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S400-S400
Author(s):  
Thomas Robinson ◽  
Ronnie Rosenthal
Keyword(s):  
Older Adults ◽  
Quality Improvement ◽  
Surgical Care ◽  
Social Needs ◽  
Geriatric Surgery ◽  
Patient Centered ◽  
Improvement Program ◽  
Continuous Quality ◽  
Operative Care ◽  
The Individual

Abstract Our program will provide a detailed overview with an emphasis on the research aspects of the new Coalition for Quality in Geriatric Surgery, a project supported by the American College of Surgeons and the John A. Hartford Foundation. This project is a national endeavor which aims to systematically improve the surgical care of older adults by establishing a verifiable quality improvement program with standards based on best evidence focused on what matters most to the individual patient. We believe there is a critical need for safe, high-quality, patient-centered surgical care for older adults. Aging surgical patients have unique physiological needs, social needs and unique goals of care. We formed the Coalition to help hospitals meet these rising needs by setting and verifying interdisciplinary standards and developing outcome measures that matter to older patients, families and caregivers. In collaboration with our 50+ stakeholder organizations, we have set the standards, developed measures that matter, educated providers and patients, and created awareness about the surgical needs of older adults at all hospitals through the program. The geriatric surgery program, set to launch in the Summer of 2019, will use the four principles of continuous quality improvement: set standards, define the right infrastructure, collect rigorous data, and verify. The program not only improves perioperative care, but also impacts the full cycle of care for older adults. Our group has harnessed the power of networks through partnership and collaboration of all disciplines involved in the peri-operative care of older adults.

scholarly journals INTERDISCIPLINARY CURRICULUM FOR THE CARE OF OLDER ADULTS: CREATING NETWORKS OF COLLABORATIVE LEARNERS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S294-S294
Author(s):  
Pamela Yankeelov ◽  
Anna Faul ◽  
Joe D'Ambrosio ◽  
and Samantha G Cotton
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Self Efficacy ◽  
Interprofessional Education ◽  
Evaluation Model ◽  
Interdisciplinary Approach ◽  
Knowledge Score ◽  
Interdisciplinary Teams ◽  
Multiple Chronic Conditions ◽  
Patient Centered

Abstract Serving older adults with multiple chronic conditions and variable social, emotional, or physical support effectively within the primary care setting requires an interdisciplinary approach to care. Our GWEP program has developed an interprofessional education center that educates and prepares students and professionals from social work, medicine, nursing, dentistry, pharmacy, and community health partners, to function within a transformed integrated patient-centered geriatric primary care and community-based service delivery system. Learners from multiple disciplines attend a face-to-face Interdisciplinary Case Management Experience (ICME) session lasting 2.5 hours. Sessions include learners from each discipline and, if possible, at least one community practitioner in small groups of 6–8 learners at each table facilitated by 1 faculty member. Approximately 1,200 learners have received the curriculum. To evaluate the program, Kirkpatrick’s Training Evaluation Model was used to determine if learners were satisfied with the content, skilled, and confident in their abilities to utilize the curriculum. Learners completed a satisfaction survey after taking each module, along with an interdisciplinary geriatric care knowledge test and self-efficacy test before and after taking each module to measure learning outcomes. Analysis showed that learners, irrespective of discipline, were satisfied with the program. All disciplines showed a significant increase from pre- to posttest for all 5 online modules achieving a mean post-knowledge score of 85% across all 5 online training modules. All disciplines experienced significant differences in their self-efficacy with working on interdisciplinary teams from pre to post ICME. Implications for future interprofessional curriculum will be discussed.

Interdisciplinary Therapy Assessments for the Older Adult

2012 ◽  
Vol 17 (1) ◽  
pp. 11-16
Author(s):  
Lynn Chatfield ◽  
Sandra Christos ◽  
Michael McGregor
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Standardized Testing ◽  
Health Care Providers ◽  
Outcome Measurement ◽  
Care Providers ◽  
Patient Centered ◽  
Screening Process ◽  
Evidenced Based ◽  
Changing Economy

In a changing economy and a changing industry, health care providers need to complete thorough, comprehensive, and efficient assessments that provide both an accurate depiction of the patient's deficits and a blueprint to the path of treatment for older adults. Through standardized testing and observations as well as the goals and evidenced-based treatment plans we have devised, health care providers can maximize outcomes and the functional levels of patients. In this article, we review an interdisciplinary assessment that involves speech-language pathology, occupational therapy, physical therapy, and respiratory therapy to work with older adults in health care settings. Using the approach, we will examine the benefits of collaboration between disciplines, an interdisciplinary screening process, and the importance of sharing information from comprehensive discipline-specific evaluations. We also will discuss the importance of having an understanding of the varied scopes of practice, the utilization of outcome measurement tools, and a patient-centered assessment approach to care.

GPS' PERCEPTION OF THE PATIENT ORIENTED INTERVENTIONS AS KEY ELEMENTS OF PATIENT CENTRED CARE FOR PEOPLE WITH MULTIMORBIDITY.pdf

2018 ◽  
Vol 28 (2) ◽  
pp. 561-565
Author(s):  
Radost Assenova ◽  
Levena Kireva ◽  
Gergana Foreva
Keyword(s):  
Chronic Conditions ◽  
Patient Centered Care ◽  
Self Management ◽  
Multiple Chronic Conditions ◽  
Positive Health ◽  
Patient Centered ◽  
Effective Response ◽  
Patient Centred Care ◽  
Centered Care ◽  
Health Related

Background: Patients with multimorbidity represent a significant portion of the primary healthcare population. For healthcare providers, managing patients with multiple chronic conditions represents a challenge given the complexity and the intensity of interventions. Integrated and patient-centered care is considered an effective response to the needs of people who suffer from multiple chronic conditions. According to the literature providing patient-centered care is one of the most important interventions in terms of positive health-related outcomes for patients with multimorbidity.Aim: The aim of the study is to evaluate the GPs’ perception of patient oriented interventions as key elements of patient centred care for patients with multimorbidity.Material and methods: A cross-sectional pilot study was conducted among randomly selected 73 GPs. A direct individual anonymous survey was performed to explore the opinion of respondents about the importance of two patient-oriented interventions, each one including specific elements of patient-centered care for patients with multimorbidity. The tool was developed as a result of the scoping review performed by Smith et al. (2012;2016). A 5-point Likert scale (0-not at all, 1-little, 2-rather, 3-much, 4-very strong) was used. The data were analysed using descriptive statistics. In processing the data, the software product for statistical analyses - SPSS version 17 was performed for Windows XP.Results: Our results show that both categories - providing patient-oriented approach and self-management support interventions were highly accessed by the respondents. The most frequent categories of interventions identified in our study were Creating individualized and adapted interventions, Performing regular contacts and Reinforcing adherence. Less frequently reported elements such as Considering relatives’ needs and Developing self-management plan are still underestimated by the Bulgarian GPs.Conclusions: The acceptance and understanding of innovative patient-centered interventions adapted to patients with multimorbidity could be accepted as a good indicator for improving health-related outcomes and care for patients with multiple chronic conditions.

scholarly journals Older adults report cancellation or avoidance of medical care during the COVID-19 pandemic: results from the Longitudinal Aging Study Amsterdam

2021 ◽  
Author(s):  
Noah A. Schuster ◽  
Sascha de Breij ◽  
Laura A. Schaap ◽  
Natasja M. van Schoor ◽  
Mike J. L. Peters ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Medical Care ◽  
Help Seeking ◽  
Community Dwelling ◽  
Multiple Chronic Conditions ◽  
Hospital Outpatient ◽  
Longitudinal Aging Study Amsterdam ◽  
Aging Study ◽  
Longitudinal Aging Study

Abstract Purpose Delay of routine medical care during the COVID-19 pandemic may have serious consequences for the health and functioning of older adults. The aim of this study was to investigate whether older adults reported cancellation or avoidance of medical care during the first months of the COVID-19 pandemic, and to explore associations with health and socio-demographic characteristics. Methods Cross-sectional data of 880 older adults aged ≥ 62 years (mean age 73.4 years, 50.3% female) were used from the COVID-19 questionnaire of the Longitudinal Aging Study Amsterdam, a cohort study among community-dwelling older adults in the Netherlands. Cancellation and avoidance of care were assessed by self-report, and covered questions on cancellation of primary care (general practitioner), cancellation of hospital outpatient care, and postponed help-seeking. Respondent characteristics included age, sex, educational level, loneliness, depression, anxiety, frailty, multimorbidity and information on quarantine. Results 35% of the sample reported cancellations due to the COVID-19 situation, either initiated by the respondent (12%) or by healthcare professionals (29%). Postponed help-seeking was reported by 8% of the sample. Multimorbidity was associated with healthcare-initiated cancellations (primary care OR = 1.92, 95% CI = 1.09–3.50; hospital OR = 1.86, 95% CI = 1.28–2.74) and respondent-initiated hospital outpatient cancellations (OR = 2.02, 95% CI = 1.04–4.12). Depressive symptoms were associated with postponed help-seeking (OR = 1.15, 95% CI = 1.06–1.24). Conclusion About one third of the study sample reported cancellation or avoidance of medical care during the first months of the pandemic, and this was more common among those with multiple chronic conditions. How this impacts outcomes in the long term should be investigated in future research.

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