Good Medical Care for the Elderly and How to Get It

The checklist | A simple way to reduce medical error

In the December 10, 2008 issue of the New Yorker, author Atul Gawande writes: “If something so simple [as a checklist] can transform intensive care, what else can it do?”

Gawande gives some amazing examples of extraordinary ICU care evolving through the use of checklists. ICU care is complicated. A time and motion study of ICU care in Israel was cited. The study showed that the average ICU patient required 178 individual actions per day, ranging from administering a drug to suctioning the lungs. Any kind of mistake, in the procedure or in the sequence of actions, could result in fatal error.

Patients & caregivers as partners in care

Jim Conway, chairman of The Partnership for Healthcare Excellence and senior vice president of the Institute for Healthcare Improvement was a featured Op-Ed writer in the Boston Globe on October 29, 2007.

Conway advocates for partnerships between patients, their advocates and the healthcare system. These key points are part of his important message:

Informed, empowered, and engaged patients are key to preventing medical errors and improving the quality of healthcare

Patients who view themselves as partners in their care

• seek doctors and hospitals who provide quality of care
• are empowered to ask more questions about their conditions and to more accurately describe their symptoms
• are better able to comply with treatment regimens because they understand them

What keeps patients from being actively involved in their treatment decisions? Conway says that evidence indicates it’s a lack of knowledge. He says that his partnership is working to empower patients and caregivers by providing them with information on crucial topics such as medication safety, how to choose a doctor or hospital, how to make the most of doctor or hospital visits, etc.

You may read Conway’s editorial, Partnering for better care here.

Health Vault - online medical records

Is this what we've been waiting for? Continuity of care is enhanced when consumers' medical team has access to a broad health record of patients. Microsoft announced on October 4, 2007 a free online service where folks can store their personal health records. Called HealthVault, this is an online project based upon two years of collaboration with partners Johnson & Johnson, the American Heart Association, the Mayo Clinic, and numerous hospitals. Of course, privacy is a huge issue. According to the New York Times, each individual putting his or her health information online will do so in secure, encrypted files. The individual is in charge of setting the privacy controls and can decide what information goes into the files and who can have access to it. Take a look and judge for yourself. Microsoft HealthVault can be accessed at www.healthvault.com

Read the New York Times article, Microsoft Offers System to Track Health Records.

Take a look and judge for yourself. Microsoft HealthVault can be accessed at www.healthvault.com

Read the New York Times article, Microsoft Offers System to Track Health Records.

Technorati tags:health vault, online medical records

Advance planning is essential for seniors

Get It All on Paper: Without Vital Documents, Aging and Incapacity Put Families in a Terrible Bind, published in the Washington Post on Sunday, March 25, 2007 outlines the safeguards that families can put in place so that their financial and health care decisions are made as appropriate.

It's important to ensure that seniors have a durable power of attorney so that a stroke or a decrease in mental competency due to Alzheimer's disease or other conditions do not prevent a spouse or adult children from making necessary financial decisions that will allow a senior to qualify for Medicaid or to sell a home, when needed, as a senior moves to assisted living, etc.

Health care advance directives are also necessary documents to ensure that a spouse or other responsible adult may make health care decisions consistent with the express written wishes of a senior who becomes unable to participate in making those decisions.

You may read what AARP and the American Bar Association recommend as essential necessary advance planning in the Washington Post article.

The Care Transitions Program: Reducing Medical Error Through Support from a Transition Coach

I was very interested and enthused recently to learn about The Care Transitions Program under the leadership of Dr. Eric Coleman, MD, MPH, associate professor of medicine in the division of Health Care Policy and Research at Colorado University Health Sciences Center. The goal of the Care Transitions Program is to improve the quality and safety of transitions of patients with complex care needs from the hospital to another care facility, whether that be home care, nursing home or rehabilitation care, or assisted living.

The Care Transitions Program uses “Transition Coaches” to meet with patients and their caregivers before the patients even leave the hospital so that they understand the medical issues involved and also the medications that have been prescribed for treatment. The transition coach will continue to visit in the home setting with family caregivers and discharged patients. In the home, there is no doctor or nurse to see any of the red flags that indicate that there is an emerging medical crisis that needs attention from a doctor or nurse.

During this 4-week program, patients with complex care needs are supported by a “Transition Coach” from whom they receive specific tools and learn self-management skills. The coach teaches patients and their caregivers to keep personal health records so that they can track changes in status, to recognize changes in status as red flags indicating an emerging medical crisis, and to advocate for early intervention so that medical errors are detected early, diagnosed and treated, thus ensuring a better outcome for the patient.