Gordon and Betty Moore Foundation Patient Care Program: Mid-Course Review of the High-Need Patients Investigation

The Gordon and Betty Moore Foundation has published a report that provides an overview of funder and grantee work in serious illness care, particularly as it relates to the high-need patient population. Available on their website, the document covers accomplishments, impact, durability and lessons learned from grants related to the priority areas in workforce and accountability and payment. The Health Teams for Frail Elders Project is a component of the Moore Foundation’s Workforce portfolio through the grant titled “Aging Patients and Health Professionals: New Roles in a Changing Health System”. Key themes from the report include:
1. The importance of paid and unpaid caregiver inclusion in health care teams
2. Filling the workforce gap in terms of knowledge, skill and supply to best provide serious illness care to an aging population
3. Improving communication skills of providers around late-life and end-of-life care

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National Forum of State Nursing Workforce Centers Annual Conference

The National Forum of State Nursing Workforce Centers was held in Denver CO at the historic Brown Palace Hotel from June 12-14.

Our team was well represented. Karen Donelan presented “Models of Care for Frail Older Adults Living in the Community”, bringing together recent research from two projects on the roles of nurses and social workers in care management. Peter Buerhaus was one of the Conference leaders, and gave the opening plenary address focusing on trends in the nursing workforce. Joanne Spetz’s team from UCSF was well represented with 5 presentations: “Strengthening the Nursing Workforce to Care for People with Serious Illness: Recommendations from a National Summit”, “Describing Workforce Demand: Three States’ Data Collection and Dissemination Approaches and Examples of Uses of the Data”, “Developing Regional Forecasts of Nursing Supply and Demand: Data and Methodological Challenges”, “The Effect of Nurse Practitioner and Physician Assistant Regulations on the Growth of the Opioid Treatment Workforce” and “Nurse Workforce Supply and Demand Projections: How Different Models and Source Data Influence the Results”. Other plenaries included David Cutler from the Department of Economics at Harvard and Lynda Benton from The Johnson&Johnson Campaign for Nursing’s Future, where exciting new initiatives are underway to support nursing innovation and leadership.

2019 Partners Population Health Research Symposium

cmichaelpophealthOn June 10th, we attended the 2019 Partners Healthcare Population Health Research Symposium in Somerville, MA. Posters presented by our team included “Social Work in Health and Aging: Past, Present, & Future” as well as “The Roles of Registered Nurse and Social Work Care Managers in Care Management.” Other projects of interest to our team on display at the symposium were “Implementing a Community Health Worker Intervention at Hospital Discharge” presented by Dr. Jocelyn Carter, director of the Community Care Transitions Initiative at MGH, “Collaborating with an External Vendor to  Implement a Home Based Care Management Program” presented by Maryann Vienneau, Program Director for iCMP and Palliative Care at Partners, and “Home Visits for Our Homebound, Best Care Model”, presented by Jennifer Wright, Population Health Program Director at Newton-Wellesley Hospital.

New Special Issue of Health Affairs: Community Care for High-Need Patients Released June 4, 2019

We are pleased to have our work included in a new special issue of Health Affairs!

The June 2019 issue of Health Affairs examines the increasing challenge of developing community approaches to caring for people with serious illness and the frailties of aging. This special issue devoted to understanding how we can recruit, train and deploy the necessary clinical and non-clinical workforce and fully integrate family caregivers into care processes. A briefing of the issue was held on June 4th in Washington DC.

Our first paper was presented at the briefing by Karen Donelan: Care Management For Older Adults: The Roles of Nurses, Social Workers, and Physicians
Authors: Karen Donelan, Yuchiao Chang, Julie Berrett-Abebe, Joanne Spetz, David Auerbach, Linda Norman and Peter Buerhaus.

Health Affairs
(Image Credit: Health Affairs)

Our colleague Joanne Spetz also has an article in this issue: Home And Community-Based Workforce For Patients With Serious Illness Requires Support To Meet Growing Needs
Authors: Joanne Spetz, Robyn Stone, Susan Chapman, and Natasha Bryant

Drawing from the 2018 survey we conducted with clinicians in primary care and geriatric practices, we focus on professional staff roles in care management, care coordination and social issues assessment.  Key takeaways:

  1. Many practices do not employ registered nurse and social worker professionals.
  2.  When both RN and SW are present, care coordination and assessment of social issues work shifts to those professionals, and physician time in these activities decreases
  3.  Further research is needed to understand how to build effective and efficient teams in these areas, and how to assure that community primary care practices have adequate staffing

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Journal of the American Geriatrics Society Special Issue on the Workforce for Seriously Ill Frail Older Adults in the Community

A new special issue of the Journal of the American Geriatrics Society presents seven papers commissioned to promote discussion of concrete recommendations from a Workforce Summit convened in Napa in May 2018 that we attended, sponsored by the Gordon and Betty Moore Foundation. Joanne Spetz, conference convener and member of our Health Teams for Frail Older Adults project, shares the summary of recommendations in an issue that discusses how to best ensure an adequate workforce for individuals with serious illness in the community. Steve Bartels, new director of the MGH Mongan Institute, also has work included in the issue with his colleague from the Dartmouth Centers for Health and Aging titled Addressing the Community-Based Geriatric Healthcare Workforce Shortage by Leveraging the Potential of Interprofessional Teams. Check out the issue online, and a previous blog by Joanne in Health Affairs sharing recommendations from the summit.


Introduction: Health Teams for Frail Older Adults Project

The U.S. population is aging and our society will need innovative solutions to provide health care to an increasing population of older adults. As our team thought about the population where innovation in health care delivery was most urgently needed we thought of our family members, colleagues and patients who struggle most with the complexities of our system. Frail older adults challenge us to think about how to make care simpler even when health gets complicated.

Primary care and geriatric health professionals are overworked and in short supply. Family caregivers are expected to take on more and more care.  Are better teams a solution to improving care for older adults? What health professionals and other staff do we need on those teams? What are the best roles for nurses, physicians, and social workers who care for older adults? Are patients and caregivers on those teams?

We asked these questions in site visits conducted in 2017 all over the United States to understand what health professionals do every day to care for an aging population. We invited experts to a professional meeting on health care teams.  In 2018, we conducted national surveys of frail older adults and caregivers, and a national  survey of primary care and geriatric health professionals.

In 2019, we will be sharing our findings.  We invite your questions, comments, and collaboration.

Karen Donelan, Sc.D, Ed.M., Health Policy Research Center, The Mongan Institute