Comprehensive primary care for older patients with multiple chronic conditions: "Nobody rushes you through"

Chad Boult, G. Darryl Wieland

Research output: Contribution to journalArticle

Abstract

Older patients with multiple chronic health conditions and complex health care needs often receive care that is fragmented, incomplete, inefficient, and ineffective. This article describes the case of an older woman whose case cannot be managed effectively through the customary approach of simply diagnosing and treating her individual diseases. Based on expert consensus about the available evidence, this article identifies 4 proactive, continuous processes that can substantially improve the primary care of community-dwelling older patients who have multiple chronic conditions: comprehensive assessment, evidence-based care planning and monitoring, promotion of patients' and (family caregivers') active engagement in care, and coordination of professionals in care of the patient - all tailored to the patient's goals and preferences.Three models of chronic care that include these processes and that appear to improve some aspects of the effectiveness and the efficiency of complex primary care - the Geriatric Resources for Assessment and Care of Elders (GRACE) model, Guided Care, and the Program of All-inclusive Care for the Elderly (PACE) - are described briefly, and steps toward their implementation are discussed.

Original languageEnglish (US)
Pages (from-to)1936-1943
Number of pages8
JournalJournal of the American Medical Association
Volume304
Issue number17
DOIs
StatePublished - Nov 3 2010

Fingerprint

Primary Health Care
Geriatric Assessment
Independent Living
Patient Preference
Physiologic Monitoring
Caregivers
Patient Care
Delivery of Health Care
Multiple Chronic Conditions

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Comprehensive primary care for older patients with multiple chronic conditions : "Nobody rushes you through". / Boult, Chad; Wieland, G. Darryl.

In: Journal of the American Medical Association, Vol. 304, No. 17, 03.11.2010, p. 1936-1943.

Research output: Contribution to journalArticle

@article{c2ac3fb9f6c04e16b87c744deecef194,
title = "Comprehensive primary care for older patients with multiple chronic conditions: {"}Nobody rushes you through{"}",
abstract = "Older patients with multiple chronic health conditions and complex health care needs often receive care that is fragmented, incomplete, inefficient, and ineffective. This article describes the case of an older woman whose case cannot be managed effectively through the customary approach of simply diagnosing and treating her individual diseases. Based on expert consensus about the available evidence, this article identifies 4 proactive, continuous processes that can substantially improve the primary care of community-dwelling older patients who have multiple chronic conditions: comprehensive assessment, evidence-based care planning and monitoring, promotion of patients' and (family caregivers') active engagement in care, and coordination of professionals in care of the patient - all tailored to the patient's goals and preferences.Three models of chronic care that include these processes and that appear to improve some aspects of the effectiveness and the efficiency of complex primary care - the Geriatric Resources for Assessment and Care of Elders (GRACE) model, Guided Care, and the Program of All-inclusive Care for the Elderly (PACE) - are described briefly, and steps toward their implementation are discussed.",
author = "Chad Boult and Wieland, {G. Darryl}",
year = "2010",
month = "11",
day = "3",
doi = "10.1001/jama.2010.1623",
language = "English (US)",
volume = "304",
pages = "1936--1943",
journal = "JAMA - Journal of the American Medical Association",
issn = "0098-7484",
publisher = "American Medical Association",
number = "17",

}

TY - JOUR

T1 - Comprehensive primary care for older patients with multiple chronic conditions

T2 - "Nobody rushes you through"

AU - Boult, Chad

AU - Wieland, G. Darryl

PY - 2010/11/3

Y1 - 2010/11/3

N2 - Older patients with multiple chronic health conditions and complex health care needs often receive care that is fragmented, incomplete, inefficient, and ineffective. This article describes the case of an older woman whose case cannot be managed effectively through the customary approach of simply diagnosing and treating her individual diseases. Based on expert consensus about the available evidence, this article identifies 4 proactive, continuous processes that can substantially improve the primary care of community-dwelling older patients who have multiple chronic conditions: comprehensive assessment, evidence-based care planning and monitoring, promotion of patients' and (family caregivers') active engagement in care, and coordination of professionals in care of the patient - all tailored to the patient's goals and preferences.Three models of chronic care that include these processes and that appear to improve some aspects of the effectiveness and the efficiency of complex primary care - the Geriatric Resources for Assessment and Care of Elders (GRACE) model, Guided Care, and the Program of All-inclusive Care for the Elderly (PACE) - are described briefly, and steps toward their implementation are discussed.

AB - Older patients with multiple chronic health conditions and complex health care needs often receive care that is fragmented, incomplete, inefficient, and ineffective. This article describes the case of an older woman whose case cannot be managed effectively through the customary approach of simply diagnosing and treating her individual diseases. Based on expert consensus about the available evidence, this article identifies 4 proactive, continuous processes that can substantially improve the primary care of community-dwelling older patients who have multiple chronic conditions: comprehensive assessment, evidence-based care planning and monitoring, promotion of patients' and (family caregivers') active engagement in care, and coordination of professionals in care of the patient - all tailored to the patient's goals and preferences.Three models of chronic care that include these processes and that appear to improve some aspects of the effectiveness and the efficiency of complex primary care - the Geriatric Resources for Assessment and Care of Elders (GRACE) model, Guided Care, and the Program of All-inclusive Care for the Elderly (PACE) - are described briefly, and steps toward their implementation are discussed.

UR - http://www.scopus.com/inward/record.url?scp=78049395082&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78049395082&partnerID=8YFLogxK

U2 - 10.1001/jama.2010.1623

DO - 10.1001/jama.2010.1623

M3 - Article

C2 - 21045100

AN - SCOPUS:78049395082

VL - 304

SP - 1936

EP - 1943

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0098-7484

IS - 17

ER -