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Showing posts from June, 2009

Challenges for Emergency Departments: Incorporating Palliative and Geriatric Care

The most recent issue of Annals of Emergency Medicine included several interesting articles about the role of geriatrics and palliative care in the emergency department . In the spirit of full disclosure, I wrote one of the articles in collaboration with a group from Harvard, and the intersection of geriatrics, palliative medicine, and emergency department care is a special interest of mine. My study used focus groups with emergency medicine providers (doctors, nurses, social workers, ED technicians) to explore perspectives of palliative care in the emergency department. We found emergency medicine providers were surprised to find that palliative care could be delivered simultaneously with life-prolonging care, that communication with outpatient providers was a major concern, and that providers sought additional skills training in communication and pain and symptom management . We described several poignant stories of emergency care gone awry , due to failures of communication, confl

An apple a day keeps the doctor away - but it will cost you!

On the heals of the Atul Gawande piece in the New Yorker , Dr. Abraham Vergese wrote an interesting cover article today in the Wall Street Journal on the Myth of Prevention . It is more of a thought piece then something that tries to make a clear and persuasive argument. The main point he tries to make is that “preventative medicine” promoting drugs and tests like coronary artery calcium scans won’t actually result in cost savings. Screening tests will only find conditions that will require further testing, retesting, and life-long therapies that may only benefit a small subset of patients (think PSAs in the elderly). He argues that the only way to control costs is by government wielding greater influence in health care. This is not a novel view point by any means but it is a stance that is a rarity to find in the Wall Street Journal.  More intriguing though was a short discussion on how Medicare’s reimbursement scheme is partly to blame for what President Obama called “a system of i

Support the Independence at Home Act

If you are interested in advocating for improved care for patients with multiple chronic illnesses, or just fed up with how care is delivered for the most frail, vulnerable, and costly Medicare beneficiaries, it's time to act. Congress has in it's lap the Independence at Home Act of 2009. This act amends title XVIII of the Social Security Act to authorize voluntary home care coordination pilot programs for high-cost Medicare beneficiaries with multiple chronic conditions. These pilot programs would focus on beneficiaries with two or more specified high cost chronic illnesses that have utilized certain Medicare benefits in the past 12 months, and that have an inability to perform two or more ADLs. The pilot programs will put together a team that consists of health care professionals directed by a qualified IAH physician or nurse practitioner who coordinates health care across all treatment settings. Best of all these programs will pay for themselves out of the gate because they

About GeriPal

Mission: GeriPal (Geriatrics and Palliative care) is a forum for discourse, recent news and research, and freethinking commentary. Our objectives are: 1) to create an online community of interdisciplinary providers interested in geriatrics or palliative care; 2) to provide an open forum for the exchange of ideas and disruptive commentary that changes clinical practice and health care policy; and 3) to change the world. We aim to be inclusive. We welcome the perspectives of generalists, specialists, gerontologists, palliative care clinicians, and anyone else interested in care of the elderly or palliative care. Contributors include: Theresa Allison Bob Arnold Helen Chen Ken Covinsky Anne Johnson Bree Johnston Helen Kao Chrissy Kistler Leslie Kernisan Sei Lee Susan Lysaght Dan Matlock Brad Miller Carla Perissinotto VJ Periyakoil Alex Smith Mike Steinman Brad Stuart Rebecca Sudore Paul Tatum Ori Tzvieli Patrice Villars Ron Walent Eric Widera  If you are intere

Geriatrics and Palliative Care Links

We are populating a new list of links for national geriatrics and palliative care organizations (in addition to the blog role that is on our main page).  Let us know if you have other sites that you think should be on this list! Geriatrics Links American Geriatrics Society : The American Geriatrics Society (AGS) is a not-for-profit organization of health professionals devoted to improving the health, independence and quality of life of all older people. Administration on Aging (AOA) : The mission of the Administration on Aging is to help elderly individuals maintain their dignity and independence in their homes and communities through comprehensive, coordinated, and cost effective systems of long-term care, and livable communities across the U.S. American Academy of Home Care Physicians (AAHCP ): The American Academy of Home Care Physicians serves the needs of thousands of physicians and related professionals and agencies interested in improving care of patients in the home. Ame