Boult Chad, Christmas Colleen, Durso Samuel C, Leff Bruce, Boult Lisa B, Fried Linda P
Roger C. Lipitz Center for Integrated Health Care, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA.
Acad Med. 2008 Jul;83(7):627-31. doi: 10.1097/ACM.0b013e3181782b14.
The size and impending morbidity of the aging baby boom generation could soon overwhelm the U.S. health care system. Transforming chronic care for older persons to avert this calamity will require rapid increases in the number of physicians who are skilled in providing chronic care and prompt adoption of new models for providing high-quality, cost-effective chronic care. The authors propose a new approach for attaining these objectives, recommending that today's leaders of academic medicine help transform geriatrics into a collaborative discipline of clinicians with advanced skills in leading educational, organizational, and research-related initiatives; that they support the collaboration of geriatrics with primary care and specialty disciplines in preparing physicians to practice effectively in new models of chronic care for older persons; and that they energetically promote rigorous training in chronic care at all levels of medical education. Implementing this strategy would require firm commitment by the Association of American Medical Colleges, specialty boards, accrediting organizations, academic institutions, the Centers for Medicare and Medicaid Services, legislators, and business leaders. Although garnering such support would be challenging and controversial, this approach could leverage the expertise of geriatric educator-leaders to help transform chronic care in the United States and to make high-quality, cost-effective chronic care accessible to most chronically ill Americans within 20 years.
生育高峰期出生的一代人口老龄化，其规模以及即将出现的发病率可能很快使美国医疗保健系统不堪重负。转变针对老年人的慢性病护理以避免这场灾难，将需要迅速增加能够提供慢性病护理的医生数量，并迅速采用新的模式来提供高质量、具成本效益的慢性病护理。作者们提出了一种实现这些目标的新方法，建议当今的医学学术领袖帮助将老年医学转变为一门协作性学科，让临床医生具备在引领教育、组织及研究相关举措方面的先进技能；支持老年医学与初级保健及专科领域开展协作，使医生能够为新模式下针对老年人的慢性病护理做好有效执业准备；大力推动在医学教育的各个层面开展针对慢性病护理的严格培训。实施这一战略将需要美国医学院协会、专业委员会、认证机构、学术机构、医疗保险和医疗补助服务中心、立法者以及商界领袖坚定承诺。尽管获得这种支持具有挑战性且会引发争议，但这种方法可以利用老年医学教育领导者的专业知识，帮助转变美国的慢性病护理，并在20年内让大多数慢性病美国人能够获得高质量、具成本效益的慢性病护理。
