Lally Kate M, Ducharme Constance M, Roach Rachel L, Towey Caitlin, Filinson Rachel, Tuya Fulton Ana
a Care New England Health System , USA.
b Integra Community Care Network, LLC.
Gerontol Geriatr Educ. 2019 Jan-Mar;40(1):121-131. doi: 10.1080/02701960.2018.1459595. Epub 2018 Apr 9.
There is a well-described need to increase the competence of the primary care workforce in the principles of geriatrics and palliative care, and as value-based payment models proliferate, there is increased incentive for the acquisition of these skills. Through a Geriatric Workforce Enhancement Program grant, we developed an adaptable curriculum around commonly encountered topics in palliative care and geriatrics that can be delivered to multidisciplinary clinicians in primary care settings. All participants in this training were part of an Accountable Care Organization (ACO) and were motivated to improve to care for complex older adults. A needs assessment was performed on each practice or group of learners and the curriculum was adapted accordingly. With the use of patient education and screening tools with strong validity evidence, the participants were trained in the principals of geriatrics and palliative care with a focus on advance care planning and assessing for frailty and functional decline. Comparison of pre- and post-test scores demonstrated increased confidence and knowledge in goals of care and basic geriatric assessment. Participants described feeling more able to address needs, have conversations around goals of care, and more able to recognize patients who would benefit from collaboration with geriatrics and palliative care.
提高基层医疗工作队伍在老年医学和姑息治疗原则方面的能力,这一需求已得到充分描述。随着基于价值的支付模式不断增多,获取这些技能的动机也在增强。通过一项老年医学劳动力强化项目拨款,我们围绕姑息治疗和老年医学中常见的主题开发了一门适应性课程,该课程可提供给基层医疗环境中的多学科临床医生。本次培训的所有参与者都是责任医疗组织(ACO)的成员,他们有动力改善对复杂老年患者的护理。对每个医疗机构或学习小组进行了需求评估,并据此调整了课程。通过使用具有强有力效度证据的患者教育和筛查工具,参与者接受了老年医学和姑息治疗原则方面的培训,重点是预先护理计划以及评估虚弱和功能衰退情况。前后测试分数的比较表明,参与者在护理目标和基本老年医学评估方面的信心和知识有所增加。参与者表示,他们感觉更有能力满足需求、围绕护理目标进行对话,并且更有能力识别那些将从与老年医学和姑息治疗协作中受益的患者。