Rogers Stephanie E, Ko Jocelyn S, McNicoll Lynn, Mendelson Daniel Ari
Department of Medicine, Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.
Department of Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
J Am Geriatr Soc. 2020 Aug;68(8):1714-1719. doi: 10.1111/jgs.16677. Epub 2020 Jul 6.
Many health systems are establishing geriatrics-orthopedics (Geri-Ortho) comanagement programs; however, there is paucity of published information on existing programs' variations in clinical operations, structure, and reported implementation challenges and perceived successes.
Our objective was to obtain detailed information about the variety of existing Geri-Ortho comanagement programs in the United States.
DESIGN/PARTICPANTS: We conducted a cross-sectional survey of 44 existing Geri-Ortho comanagement programs, with 23 (52%) of programs responding.
Quantitative questions were used to assess operational, staffing, and financial structures; and qualitative questions were used to identify reported challenges and perceived successes of implementation.
Programs self-identified as urban (n = 23), academic (n = 20), or nonprofit (n = 22) and as having a level I trauma center (n = 17). Most programs (n = 18) were funded fully by the institution. Fourteen programs used geriatricians, and nine used medicine/hospitalists as the supporting clinical service, whereas approximately half (n = 11) used these services in a true comanagement model. Six universal themes were identified as necessary for program implementation. The most commonly described successes perceived by all respondents were improvements in clinical outcomes and better interdisciplinary relationships. Reported challenges included difficulty in interdisciplinary geriatrics education, difficulty in adherence to protocols, and lack of funding for staffing.
There are diverse types of Geri-Ortho comanagement programs in the United States, although universal elements exist. Many had similar challenges in implementation, and further studies are needed to determine which implementation elements are critical to clinical and financial outcomes. J Am Geriatr Soc 68:1714-1719, 2020.
许多医疗系统正在建立老年医学 - 骨科（Geri-Ortho）联合管理项目；然而，关于现有项目在临床操作、结构以及报告的实施挑战和感知到的成功方面的差异，公开信息匮乏。
我们的目的是获取有关美国现有各类Geri-Ortho联合管理项目的详细信息。
设计/参与者：我们对44个现有的Geri-Ortho联合管理项目进行了横断面调查，其中23个项目（52%）做出了回应。
定量问题用于评估运营、人员配备和财务结构；定性问题用于确定报告的挑战和实施过程中感知到的成功。
各项目自我认定为城市项目（n = 23）、学术项目（n = 20）或非营利项目（n = 22），并且有一级创伤中心（n = 17）。大多数项目（n = 18）由机构全额资助。14个项目使用老年医学专家，9个项目使用内科医生/住院医师作为支持临床服务，而大约一半（n = 11）在真正的联合管理模式中使用这些服务。确定了六个项目实施所需的普遍主题。所有受访者普遍描述的成功之处在于临床结果的改善和更好的跨学科关系。报告的挑战包括跨学科老年医学教育困难、遵守方案困难以及人员配备资金不足。
美国存在多种类型的Geri-Ortho联合管理项目，尽管存在一些普遍要素。许多项目在实施过程中面临类似挑战，需要进一步研究以确定哪些实施要素对临床和财务结果至关重要。《美国老年医学会杂志》2020年；68：1714 - 1719。
