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Exploring Human Potential

Candidates Should Read Dr. David Reuben’s Article

Posted on | January 30, 2008 | No Comments

Better care for older persons means better care for all of us

David Reuben, MDDr. David Reuben from UCLA penned an article in JAMA in December, 2007 that all Presidential candidates should read. In two concise pages he shares six principles that he sees as essential in providing "optimal health care delivery for older persons with chronic disease." These principles are on the mark, and apply not just to older Americans with chronic disease, but to all Americans of all ages. Here are the principles:

1. "Care must be personalized to meet each patient’s goals, values and resources…influenced by the patient’s age, health, function, economic and social situations, ethnicity and culture."

2. "Care should be provided in accordance with best practices…evidence based when evidence is available…and through consensus/expert panels (when evidence is unavailable).".

3. "Physicians can not do the job alone..Team care…is essential."

4. "Care must be coordinated among those caring for patients…All information must be available….A necessary, but not the sole, requirement is an electronic health record."

5. "Care must consider resources and environment of the person…With aging…the support systems become tenuous…Herein lies the value of home visits for many interventions and assessment of social support in all successful models of care."

6. "Older persons must be included as active partners in their care….Patients families and friends are also part of this partnership."

Additional insight:  "…change has been exceptionally difficult because of the outmoted financing systems, slow adoption of information technology, and overwhelming inertia in all sectors of the health care delivery system…Nevertheless, as health care reform gathers momentum, there may be hope for payment changes…The Patient-Centered Medical Home advocated by internists, family physicians and pediatricians promotes many of these principles and may offer a means for implementing innovative models on a wider scale."

(Mike Magee, MD, can be reached at drmikemagee@gmail.com.)

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