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2006 National Awards of Excellence Presented

SHM selected Andrew Auerbach, MD, and Greg Maynard, MD, to attend the Assessing the Care of Vulnerable Elders meeting in March. The panel will discuss quality indicators for hospital care, peri-operative care, diabetes, COPD, osteoarthritis, osteoporosis, pressure ulcers, and benign prostatic hyperplasia as they relate to elder care.

The Pay for Performance (P4P) Task Force was recently created to respond to regulatory and legislative initiatives related to P4P. The task force is charged with:

  • Educating SHM members on federal P4P initiatives and how they affect hospital medicine, and
  • Responding to and formulating SHM position statements and input on P4P programs and legislation.

In the future the HQPSC will review quality indicators proposed by major quality organizations in terms of how relevant they are to hospitalists and hospital medicine. We are working with the SHM Public Policy Committee to ensure that SHM has a representative in the national P4P and quality indicator selection discussion.

Chapter Updates ONLINE

For additional information on SHM chapters visit www.hospitalmedicine.org and click on “Chapters.”

JHM Up Close

Barriers and opportunities in caring for the elderly

By Norra MacReady

In 2002 people age 65 years and older accounted for 12% of the population and a whopping 50% of all hospitalizations unrelated to childbirth. The ranks of senior citizens are increasing by 1 million per year in the U.S. and are expected swell to 21% of the population by 2030.

Surprisingly, hospitalists know little about how best to care for the elderly, writes C. Seth Landefeld, MD, in the January/February issue of the Journal of Hospital Medicine. “Hospitalists are good at taking care of acute illnesses like GI bleeding or cardiovascular problems, but they often don’t receive extensive training in problems that occur with aging, like delirium, cognitive impairment, or limitations in mobility,” Dr. Landefeld tells The Hospitalist.

For his article, Dr. Landefeld reviewed the medical literature published since 1980 that covers the course of these patients during and after hospitalization, and he identified gaps in knowledge and treatment strategies.

Clinical trials often include few if any seniors, yet conventional treatments for such common conditions as acute myocardial infarction and delirium may become less effective with age, suggesting that many drugs should be tested in this population.

What’s more, a hospitalized older person is likely to have several comorbidities, as well as cognitive impairment or dementia. As many as one-third of elderly patients have not recovered their baseline function by the time of hospital discharge and can no longer live at home.

Hospitalists are good at taking care of acute illnesses like GI bleeding or cardiovascular problems, but they often they don’t receive extensive training in problems that occur with aging, like delirium, cognitive impairment, or limitations in mobility.

—C. Seth Landefeld, MD

There are effective, evidence-based ways to prevent functional disability and delirium—two syndromes common in hospitalized elderly people, writes Dr. Landefeld, who is professor of medicine and chief of the Division of Geriatrics at the University of California, San Francisco. Comprehensive assessment, targeted treatment, and environmental modifications that promote independence and safety can reduce the incidence of both.

All of this could be accomplished with no increase in hospital costs, but several barriers stand in the way, including lack of knowledge about the needs of elderly patients and systems of care that emphasize mechanisms and efficiency over disease management and structured clinical care. Hospitalists trained to maximize outcomes and send patients home as soon as possible may be unaware of the complexity of the issues involved in caring for the very old.

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