Tuesday, May 17, 2016

Steve: Geriatric care The Swedish way

These are shops where local artists display their work.

It's been cool and rainy for the past 4 days. I went out today with the maximum layers I could put on.  The students have remained focused and uncomplaining despite the weather. What we are learning is compelling.

Today the focus was health care. We traveled to Ryhov, which is the regional hospital, to meet with the geriatrics team.

There is much that can be admired in Swedish health care. It is affordable and there is universal coverage. For example, the maximum out of pocket payment for medications is SEK 1500, or less than $200. PER YEAR. Quality is high.

Sweden struggles, however, with the same problems as we do--a growing older population and rising costs. The geriatrics team told us about 2 innovative projects that they are conducting to help the most complex and challenging patients--people who have multiple health problems who tend to go in and out of the hospital and are likely to end up in nursing homes.

The first project is a mobile geriatric team. The goal is to stop the revolving door between hospital and home by bringing care into the home. Patients who are 75+ and have been hospitalized 3 times or more in the past year are eligible to receive care from the mobile team. The team does follow-up from the most recent hospitalization and makes sure all the follow-up care is being done. The team leader, Dr. Daniel Gustavson, called it "Sitting at the kitchen table."  It's where you have an honest, person to person conversation, find out the patient's goals and learn what's really going on so that the team can do what's needed to help the patient stay at home.

As an example, at the initial meeting, which can last 1 1/2 hours, the geriatrician and nurse  check the patient's medications. According to Dr. Gustavson, only 5 of 150 patients visited so far had the correct list of medications to take.

Home visits continue for up to 2 weeks, until the patient's situation stabilizes, and patients or their family can call the team if they have questions or run into difficulties. 

The project is still being evaluated, but so far it has shown a 62% reduction in hospital days among people receiving the mobile team compared to a control group. You can view a video of that describes more about the team at:

The second project is called ESTHER and takes place in another town in the county. While the mobile team concentrates on follow up of medical care in the home, ESTHER works to bring together all the people and agencies needed to help an older person to stay at home. This includes health care, help in the home with activities of daily living, therapies and other things. The project chose the name, ESTHER, because it is a typical Swedish name among the oldest generations and the members of the project want everyone involved in providing care to ask themselves, "is this good for Esther?"  In other words, to personalize what they are doing.

As an example, after a hospitalization, members of the team provide "Welcome Back Care."  Before the older person gets home, they make sure the home is in good order, the bed is made, the right medical equipment has been available. They even put food in the refrigerator.

Like the mobile team, ESTHER lowers rates of rehospitalization


The program was chosen by CNN as one of the coolest innovations around the world. You can find an article about it by searching for Project ESTHER CNN.

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