From: Bob
Sent: Sat 11/23/2013 11:19 AM
To: Kenneth Rockwood
Subject: Newspaper - Nov 21, 2013 - Page A12
Dr. Rockwood:
Thank you so much for this thoughtful reply. As usual your thinking is very insightful.
Perhaps the extramural hospital in Antigonish may be a good start. The part they are missing is “…home visits, by cross-trained health providers…”. Having spent most of my working career in the hospital business I am in total agreement with your ideas.
Thank you for your permission to use your words. I do have a health section on our web site that a few people look at now and then.
Bob
Bob Fougere
From: Kenneth Rockwood
Sent: Saturday, November 23, 2013 3:28 AM
Subject: RE: Newspaper - Nov 21, 2013 - Page A12
I'd see that we would do three things differently:
First, we would admit fewer frail older adults to hospital, and have means of managing acute illness at home (e.g. the "hospital at home" model developed in Baltimore). There would be more home visits, by cross-trained health providers (e.g. not the parade of PT/OT/pharmacy, etc.) I also see an expanding role for paramedics in this.
Second, every patient admitted to hospital or sent to such a program would have explicit, patient-centered goals. For example, we often treat patients with pneumonia until their is better - not until they are better. Doing so would mean making sure that they could walk, function and think as before, or that we had a plan for getting them there. Too often, modern health care does to people, not for them. We need to focus on treating people to good ends: relieving pain & suffering, improving function and avoiding premature death.
Third, we would use information much more effectively. Too much is in silos, is wrong, or is never employed. This means not just an effective electronic medical record, but an open one, that would track (broadly, so as to not trump privacy concerns, although it is not clear that privacy should have the trumping status that it now does) an individual's health span (how functional are they, how much pain, etc.) and life space (how much do they get out? how much are they seen by others?). In other words, we would concern ourselves with the health of older people, and not just their illnesses.
Thanks for asking. Feel free to quote me.
regards
KR
Kenneth Rockwood, MD, FRCPC, FRCP
Professor of Medicine (Geriatric Medicine & Neurology)
Kathryn Allen Weldon Professor of Alzheimer Research
Dalhousie University
Halifax, NS Canada
From: Bob
Sent: November-22-13 5:17 PM
To: Kenneth Rockwood
Subject: Newspaper - Nov 21, 2013 - Page A12
Dr. Rockwood:
I read, with a great deal of interest, the above article in the Chronicle Herald – I understand that you are calling for more education of health providers, at all levels, in the needs of the frail. What I would like to get more clarity on is your view on the how to of “...hospital and long-term care (being) a big ship to turn.” If we could turn it, what would we be seeing that is different from what we see now (besides more and better educated providers)?
Bob
Bob Fougere