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Key Elements of High-Quality Primary Care for Vulnerable Elders

Journal of General Internal Medicine volume 23, pages 2018–2023 (2008)Cite this article

Abstract

With the impending surge in the number of older adults, primary care clinicians will increasingly need to manage the care of vulnerable elders. Caring for vulnerable elders is complex because of their wide range of health goals and the interdependence of medical care and community supports needed to achieve those goals. In this article, we identify ways a primary care practice can reorganize to improve the care of vulnerable elders. We begin by identifying important outcomes for vulnerable elders and three key processes of care (communication, developing a personal care plan for each patient, and care coordination) needed to achieve these outcomes. We then describe two delivery models of primary care for vulnerable elders – co-management, and augmented primary care. Finally, we discuss how the physical plant, people, workflow management, and community linkages in a primary care practice can be restructured to better serve these patients.

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ACKNOWLEDGEMENTS

The authors acknowledge Linda E. Aoyama, MD, Robert H. Brook, MD, ScD, Brandon Koretz, MD, and Louise Walter, MD, for their helpful comments on earlier versions of this article. David Ganz was supported by the UCLA Claude Pepper Older Americans Independence Center funded by the National Institute on Aging (5P30AG028748) and is supported by the Veterans Affairs Health Services Research and Development Service (VA CD2 08–012–1). Shinyi Wu is supported by the Roybal Center for Health Policy Simulation funded by the National Institute on Aging (5P30AG024968–02).

Disclosures

Constance H. Fung is an employee of Zynx Health Inc., which develops evidence-based clinical decision support systems – including documentation templates and order sets – to help providers improve quality of care. The other authors have not identified any potential conflicts of interest with respect to this manuscript.

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Authors and Affiliations

  1. VA Greater Los Angeles Healthcare System (11G), Los Angeles, CA, USA

    David A. Ganz MD, PhD

  2. Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    David A. Ganz MD, PhD & David B. Reuben MD

  3. Zynx Health Incorporated, Los Angeles, CA, USA

    Constance H. Fung MD, MSHS

  4. Medical Associates Clinic, Dubuque, IA, USA

    Christine A. Sinsky MD

  5. Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA, USA

    Shinyi Wu PhD

  6. RAND Corporation, Santa Monica, CA, USA

    Shinyi Wu PhD

Authors
  1. David A. Ganz MD, PhD
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  2. Constance H. Fung MD, MSHS
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  3. Christine A. Sinsky MD
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  4. Shinyi Wu PhD
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  5. David B. Reuben MD
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Corresponding author

Correspondence to David A. Ganz MD, PhD.

Additional information

Support: David Ganz was supported by the UCLA Claude Pepper Older Americans Independence Center funded by the National Institute on Aging (5P30AG028748) and the Veterans Affairs Health Services Research and Development Service (VA CD2 08–012–1). Shinyi Wu is supported by the Roybal Center for Health Policy Simulation funded by the National Institute on Aging (5P30AG024968–02). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or Zynx Health Incorporated.

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Ganz, D.A., Fung, C.H., Sinsky, C.A. et al. Key Elements of High-Quality Primary Care for Vulnerable Elders. J GEN INTERN MED 23, 2018–2023 (2008). https://doi.org/10.1007/s11606-008-0808-5

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  • DOI: https://doi.org/10.1007/s11606-008-0808-5

KEY WORDS

  • primary care
  • practice redesign
  • quality of care
  • quality improvement
  • older adults