Key Elements of High-Quality Primary Care for Vulnerable Elders

Published In: Journal of General Internal Medicine, v. 23, no. 12, Dec. 2008, p. 2018-2023

Posted on RAND.org on December 31, 2007

by David A. Ganz, Constance Fung, Christine A. Sinsky, Shin-Yi Wu, David Reuben

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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, the authors identify ways a primary care practice can reorganize to improve the care of vulnerable elders. The authors 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, the authors 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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