IMPLEMENTING THE 4MS IN PRIMARY CARE: BUILDING AN AGE-FRIENDLY HEALTH SYSTEM

Abstract The Age Friendly Health Systems initiative is a culture change movement funded by the John A. Hartford Foundation in collaboration with the Institute for Health Care Improvement. Transforming clinical training environments into integrated geriatrics and primary care systems to become Age-Friendly Health Systems must incorporate the principles of value-based care and alternative-payment models. This symposium will discuss how the implementation of the Geriatric Interprofessional Team Transformation in Primary Care (GITT-PC) model and the Reducing Avoidable Facility Transfer Model (RAFT) in primary care will improve patient outcomes focused on the 4M’s of the Age Friendly Health System. The success of the GITT-PC model focuses on 4 Medicare reimbursable services including the Annual Wellness Visit, Transitional Care Management, Chronic Care Management and Advance Care Planning. The RAFT model focuses on What Matters Most to residents of long term care facilities and reduces ED visits and hospital transfers through elicitation of goals of care and 24 hour virtual support from an interprofessional geriatric team.

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CATCH-ON Age-Friendly Health System Implementation Across Varied Geographic and System Settings

Innovation in Aging ◽

10.1093/geroni/igaa057.2590 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 729-730

Author(s):

Erin Emery-Tiburcio ◽

Robyn Golden ◽

Michelle Newman

Keyword(s):

Primary Care ◽

Learning Community ◽

Health Systems ◽

Clinical Training ◽

Medical Center ◽

Lessons Learned ◽

Team Members ◽

Primary Care Health ◽

Care Systems ◽

Health Communities

Abstract GWEP program goals include transformation of clinical training environments into integrated geriatrics and primary care systems to become Age-Friendly Health Systems. CATCH-ON, the collaborative GWEP led by Rush University Medical Center, is working with primary care health systems in four highly varied geographic and system settings to achieve this goal. Each of these clinic systems has unique successes and challenges in developing and implementing workflow protocols; engaging providers, patients, families, and community-based organizations in the development of Age-Friendly Health Communities; and modifying the electronic health record to document assessing and acting on 4Ms. Clinic team members participate in monthly Learning Community sessions to learn about and reinforce the 4Ms, along with practical recommendations for implementing with patients. This session will focus on CATCH-ON’s process for implementing the 4Ms in various practice settings, lessons learned in implementation across large and small health systems, and opportunities to bridge AFHS with the community.

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Identifying important health system factors that influence primary care practitioners’ referrals for cancer suspicion: a European cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2018-022904 ◽

2018 ◽

Vol 8 (9) ◽

pp. e022904 ◽

Cited By ~ 5

Author(s):

Michael Harris ◽

Peter Vedsted ◽

Magdalena Esteva ◽

Peter Murchie ◽

Isabelle Aubin-Auger ◽

...

Keyword(s):

Primary Care ◽

Decision Making ◽

Factor Analysis ◽

Health System ◽

Health Systems ◽

European Countries ◽

Cancer Symptoms ◽

Referral Decision ◽

System Factors ◽

Primary Care Practitioners

ObjectivesCancer survival and stage of disease at diagnosis and treatment vary widely across Europe. These differences may be partly due to variations in access to investigations and specialists. However, evidence to explain how different national health systems influence primary care practitioners’ (PCPs’) referral decisions is lacking.This study analyses health system factors potentially influencing PCPs’ referral decision-making when consulting with patients who may have cancer, and how these vary between European countries.DesignBased on a content-validity consensus, a list of 45 items relating to a PCP’s decisions to refer patients with potential cancer symptoms for further investigation was reduced to 20 items. An online questionnaire with the 20 items was answered by PCPs on a five-point Likert scale, indicating how much each item affected their own decision-making in patients that could have cancer. An exploratory factor analysis identified the factors underlying PCPs’ referral decision-making.SettingA primary care study; 25 participating centres in 20 European countries.Participants1830 PCPs completed the survey. The median response rate for participating centres was 20.7%.Outcome measuresThe factors derived from items related to PCPs’ referral decision-making. Mean factor scores were produced for each country, allowing comparisons.ResultsFactor analysis identified five underlying factors: PCPs’ ability to refer; degree of direct patient access to secondary care; PCPs’ perceptions of being under pressure; expectations of PCPs’ role; and extent to which PCPs believe that quality comes before cost in their health systems. These accounted for 47.4% of the observed variance between individual responses.ConclusionsFive healthcare system factors influencing PCPs’ referral decision-making in 20 European countries were identified. The factors varied considerably between European countries. Knowledge of these factors could assist development of health service policies to produce better cancer outcomes, and inform future research to compare national cancer diagnostic pathways and outcomes.

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Fragmentation of Care Among Black Women With Breast Cancer and Comorbidities: The Role of Health Systems

JCO Oncology Practice ◽

10.1200/op.20.01089 ◽

2021 ◽

Vol 17 (5) ◽

pp. e637-e644 ◽

Cited By ~ 1

Author(s):

Michelle Doose ◽

Janeth I. Sanchez ◽

Joel C. Cantor ◽

Jesse J. Plascak ◽

Michael B. Steinberg ◽

...

Keyword(s):

Breast Cancer ◽

Primary Care ◽

Black Women ◽

Health System ◽

Health Systems ◽

Care Coordination ◽

Surgical Care ◽

Primary Care Visit ◽

Practice Setting ◽

Care Fragmentation

PURPOSE: Black women are disproportionately burdened by comorbidities and breast cancer. The complexities of coordinating care for multiple health conditions can lead to adverse consequences. Care coordination may be exacerbated when care is received outside the same health system, defined as care fragmentation. We examine types of practice setting for primary and breast cancer care to assess care fragmentation. MATERIALS AND METHODS: We analyzed data from a prospective cohort of Black women diagnosed with breast cancer in New Jersey who also had a prior diagnosis of diabetes and/or hypertension (N = 228). Following breast cancer diagnosis, we examined types of practice setting for first primary care visit and primary breast surgery, through medical chart abstraction, and identified whether care was used within or outside the same health system. We used multivariable logistic regression to explore sociodemographic and clinical factors associated with care fragmentation. RESULTS: Diverse primary care settings were used: medical groups (32.0%), health systems (29.4%), solo practices (23.7%), Federally Qualified Health Centers (8.3%), and independent hospitals (6.1%). Surgical care predominately occurred in health systems (79.8%), with most hospitals being Commission on Cancer–accredited. Care fragmentation was experienced by 78.5% of Black women, and individual-level factors (age, health insurance, cancer stage, and comorbidity count) were not associated with care fragmentation ( P > .05). CONCLUSION: The majority of Black breast cancer survivors with comorbidities received primary care and surgical care in different health systems, illustrating care fragmentation. Strategies for care coordination and health care delivery across health systems and practice settings are needed for health equity.

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Primary care management of older people with mental health problems

10.1093/med/9780199644957.003.0023 ◽

2013 ◽

Author(s):

Louise Robinson ◽

Carolyn Chew-Graham

Keyword(s):

Mental Health ◽

Primary Care ◽

Older People ◽

Care Management ◽

Mental Health Problems ◽

Age Groups ◽

Real Life ◽

Health Problems ◽

Care Systems ◽

Primary Care Management

This chapter discusses the presentation and primary care management of the commonest mental health problems in older people; these include delirium, delusions, depression and anxiety, and dementia. Primary care is on the front line in dealing with older people who have mental health problems, supporting their families to care for them and managing people with complex co-morbidities in addition to mental health issues. Older people consult their GP almost twice as often as other age groups and up to 40% may have a mental health problem. Cases drawn from the authors’ real-life practice are presented firstly to represent clinical presentations and management within primary care and secondly to demonstrate how primary care links with secondary care and the wider services. The management of patients is discussed largely within reference to UK primary care systems and policy, but the international readership should find parallels within their own healthcare systems.

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Roemer 20 Years Later: When a Classical Health-System Typology Meets Market-Oriented Reforms

Revue Gouvernance ◽

10.7202/1038889ar ◽

2017 ◽

Vol 9 (1) ◽

Author(s):

Melanie Bourque ◽

Jean-Simon Farrah

Keyword(s):

Health Care ◽

Health System ◽

Health Systems ◽

Public Management ◽

Health Care Services ◽

New Public Management ◽

Health Care Systems ◽

Supply And Demand ◽

Managed Competition ◽

Care Systems

In 1990, Roemer came up with a very influential health system typology. From his vast study, emerged three types of health care systems: nationalized, mandated and entrepreneurial. Health care systems are not static; slow changes and reforms somewhat alter values and goals on which those systems were initially established. It is fair to say, then, that over the last two decades, health care reformers have adopted a market-oriented governance model that blends new public management (NPM) and managed competition reforms in the provision of health care services to transform supply- and demand-side actors into “responsibilized” customers, payers or providers. These transformations beg the question as to whether we are witnessing a radical redefinition of health care systems through the implementation of market-oriented governance. We propose to add the evolution of market-oriented health reforms in five case studies to Milton Roemer’s typology of health systems. In light of our findings, we will wrap up the analysis with an assessment of the usefulness of Roemer’s classification for social scientists to grasp the evolution of health systems over the past 20 years, and more importantly, to analyze the current state of these health care systems after years of market-oriented reforms.

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Evaluating health care systems

Oxford Handbook of Public Health Practice ◽

10.1093/med/9780199586301.003.0043 ◽

2013 ◽

pp. 428-438 ◽

Cited By ~ 1

Author(s):

Martin McKee ◽

Bernadette Khoshaba ◽

Marina Karanikolos

Keyword(s):

Health Care ◽

Health System ◽

Health Systems ◽

System Performance ◽

Health Care Systems ◽

Health System Performance ◽

Care Systems

This chapter aims to help the reader understand the importance of defining the boundaries of a health system in a given country, explain the functions of a health system and how these relate to one another, describe the goals of a health system and how to evaluate progress towards them, be aware of the major contemporary initiatives to assess health system performance internationally, and recognize the limitations, including the scope for abuse, of health systems comparisons.

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Implementation of a Workflow Initiative for Integrating Transitional Care Management Codes in a Geriatric Primary Care Practice

Journal of Nursing Care Quality ◽

10.1097/ncq.0000000000000316 ◽

2018 ◽

Vol 33 (4) ◽

pp. 348-353

Author(s):

Julia Steckbeck ◽

Christi McBain ◽

Kerry L. Terrien ◽

David Isom ◽

Daniel Stadler ◽

...

Keyword(s):

Primary Care ◽

Care Management ◽

Primary Care Practice ◽

Transitional Care ◽

Care Practice

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Can Asia provide models for tax-based European health systems? A comparative study of Singapore and Sweden

Health Economics Policy and Law ◽

10.1017/s1744133120000390 ◽

2020 ◽

pp. 1-18

Author(s):

Richard B. Saltman ◽

Ming-Jui Yeh ◽

Yu Liu

Keyword(s):

Health Service ◽

Health System ◽

Health Systems ◽

Long Term Care ◽

Health Sector ◽

Chronically Ill ◽

Term Care ◽

Care Services ◽

Case Comparison

Abstract Singapore's health system generates similar levels of health outcomes as does Sweden's but for only 4.4% rather than 11.0% of gross domestic product, with Singapore's resulting health sector savings being re-directed to help fund both long-term care and retirement pensions for its elderly citizens. This paper contrasts the framework of financial risk-sharing and the configuration and management of health service providers in these two high-income, small-population countries. Two main institutional distinctions emerge from this country case comparison: (1) Key differences exist in the practical configuration of solidarity for payment of health care services, reflecting differing cultural roots and social expectations, which in turn carry substantial implications for financing long-term care and pensions. (2) Differing arrangements exist in the organization of health service institutions, in particular balancing public as against private sector responsibilities for owning, operating and managing these two countries' respective hospitals. These different structural characteristics generate fundamental differences in health sector financial and delivery outcomes in one developed country in Far East Asia as compared with a well-respected tax-funded health system in Western Europe. In the post-COVID era, as Western European policymakers find themselves forced to adjust their publicly funded health systems to (further) reductions in economic growth rates and overall tax receipts, and as the cost of the information revolution continues to rise while efforts to fund better coordinated social and home care services for growing numbers of chronically ill elderly remain inadequate, this two-country case comparison highlights a series of health system design questions that could potentially provide alternative health sector financing and service delivery strategies.

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Primary care management of older people with mental health problems

Oxford Textbook of Old Age Psychiatry ◽

10.1093/med/9780198807292.003.0022 ◽

2020 ◽

pp. 317-338

Author(s):

Louise Robinson ◽

Carolyn A Chew-Graham

Keyword(s):

Mental Health ◽

Primary Care ◽

Older People ◽

Care Management ◽

Mental Health Problems ◽

Age Groups ◽

Real Life ◽

Health Problems ◽

Care Systems ◽

Primary Care Management

This chapter discusses the presentation and primary care management of the commonest mental health problems in older people; delirium, delusions, depression and anxiety, and dementia. Primary care is on the front line in dealing with older people who have mental health problems, supporting their families to care for them, and managing people with complex comorbidities in addition to mental health issues. Older people consult their GP almost twice as often as other age groups and up to 40% of older people may have a mental health problem. The chapter presents cases drawn from the authors’ real-life practice, first, to represent clinical presentations and management within primary care; and second, to demonstrate how primary care links with secondary care and the wider services. It discusses the management of patients largely within reference to UK primary care systems and policy, but the international readership should find parallels within their own healthcare systems.

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