JAMA Highlights Delivery Models for High-Risk Older Patients

Tuesday, January 12, 2016
Brian Powers, AB
Arnold Millstein, MD, MPH
Sachin Jain, MD, MBA
Summary and Key Findings: 

In a recent article from JAMA, Delivery Models for High-Risk Older Patients Back to the Future?, authors focused on delivery models designed to remove discontinuities as older patients move back and forth between inpatient and outpatient settings. 

Author Sachin Jain, MD, MBA notes that ““For many people, this approach may harken back to the age when their primary care physician came to the hospital to take care of them. In this case, however, organizations have built systems to ensure continuity of care.” 

The two systems highlighted in the model are The University of Chicago Medicine and CareMore Health System. The article found that this continuity is currently lacking at systems with other care models, which fail to support this population of high-risk patients with multiple comorbid conditions. 

With poorly coordinated care, these conditions lead to:

  • Frequent hospitalizations,
  • Emergency department visits,
  • Increased readmission rates, and
  • Suboptimal outcomes. 

The Chicago and CareMore models offer intensive, team-based care for high risk patients. By having a doctor follow patients from the hospital to outpatient setting, the model aims to prevent health crises caused by complex chronic illnesses. 

While the results are promising—CareMore has reduced hospital stays from 5.3 days to 3.7 days—the authors note that provider coordination and effective payment models are needed to support the care models featured in JAMA’s article.

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