Developing Standards ‘Of, By, And For’ Older Adults: Reflections On Patricia Gabow’s Narrative Matters Essay

Imagine three people: a healthy 30-year-old, a 60-year-old with high blood pressure, diabetes and arthritis, and a 90-year-old who is frail and has dementia advanced to the point where her speech often doesn’t make sense. If I lined them up, any doctor could instantly tell me which was which. Ditto if each broke a bone and I showed the physicians only their x-rays. And if I asked the clinicians to predict each patient’s risk of complications and adverse events based on nothing more than the few words above, they would again rapidly and reliably make accurate assessments. Yet, for the most part, our health system lumps these three people into a single “adult” category, an approach that flies in the face of anatomy, physiology, pharmacodynamics, risk stratification, and a whole lot more, including common sense, population trends, ethics, economics, and epidemiology. As CEO and chief medical officer of a large safety net health system, Patricia Gabow, author of the powerful Narrative Matters essay in the May 2015 issue of Health Affairs, introduced evidence-based standard care pathways, computerized order entry and order sets, and Toyota’s “Lean” principles, which led to marked improvements in quality of care and health outcomes in patient populations for whom health disparities have been longstanding challenges. Such methods are now being adopted across the country and incentivized by the Affordable Care Act. Then her mother, a nonagenarian with frailty and advanc...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Health Professionals Hospitals Narrative Matters Organization and Delivery Aging End-of-Life Care Health Policy Patricia Gabow standards of care Source Type: blogs