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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