Defining the domain of geriatric medicine in an urban public health system affiliated with an academic medical center.
The American Geriatrics Society has recommended a reexamination of the roles and deployment of providers with expertise in geriatric medicine. Healthcare systems use a variety of strategies to maximize their geriatric expertise. In general, these health systems tend to focus geriatric medicine resources on a group of older adults that are locally defined as the most in need. This article describes a model of care within an academic urban public health system and describes how local characteristics interact to define the domain of geriatric medicine. This domain is defined using 4 years of data from an electronic medical record combined with data collected from clinical trials. From January 2002 to December 2005, 31,443 adults aged 65 and older were seen at any clinical site within this healthcare system. The mean age was 75 (range 65-105); 61% were women; 35% African American, and 2% Hispanic. The payer mix was 80% Medicare and 17% Medicaid. The local geriatric medicine program includes sites of care in inpatient, ambulatory, nursing home, and home-based settings. By design, this geriatric medicine clinical practice complements the care provided to older adults by the primary care practice. Primary care physicians tend to cede care to geriatric medicine for older adults with advanced disability or geriatric syndromes. This is most apparent for older adults in nursing facilities or those requiring home-based care. There is a dynamic interplay between design features, reputation, and capacity that modulates volume, location, and type of patients seen by geriatrics.
Callahan
Christopher M
CM
Department of Medicine, Center for Aging Research, School of Medicine, Indiana University, Indianapolis, Indiana 46202, USA. ccallaha@iupui.edu
Weiner
Michael
M
Counsell
Steven R
SR
D000046:Academic Medical Centers; D000368:Aged; D005853:Geriatrics; D006299:Health Services for the Aged / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007196:Indiana; D007373:Interinstitutional Relations; D010821:Physicians, Family / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D014481:United States; D014492:United States Public Health Service; D019037:Urban Health Services
J Am Geriatr Soc. 2006 Oct;54(10):1603-9
17038081
Int J Med Inform. 1999 Jun;54(3):225-53
10405881
J Am Geriatr Soc. 2000 Dec;48(12):1572-81
11129745
JAMA. 2007 Dec 12;298(22):2623-33
18073358
J Am Geriatr Soc. 2004 Aug;52(8):1384-90
15271131
J Am Geriatr Soc. 2003 Jul;51(7 Suppl):S338-45
12823665
JAMA. 2006 May 10;295(18):2148-57
16684985
J Am Geriatr Soc. 2002 Oct;50(10):1741-3
12366633
N Engl J Med. 1987 May 28;316(22):1425-8
3574423
J Am Geriatr Soc. 2005 Jun;53(6 Suppl):S245-56
15963180
JAMA. 2002 Dec 11;288(22):2836-45
12472325