Elderly inpatient care model delivered mixed results

The most important barrier to adopting coordinated models of geriatric care such as the MACE model is that it demands change from physicians who "are used to taking responsibility for only a subset of a patient’s health issues, and then only in specific settings," said Dr. Lisa M. Walke and Dr. Mary E. Tinetti.

Other obstacles include the paucity of geriatric specialists to provide this type of care, the lack of data infrastructure for sharing information across inpatient and outpatient sites of care, and the lack of a financial incentive to create such a fully integrated model. "In fact, the current disease-based fee-for-service payment structure creates a disincentive for streamlining care," they said.

Fortunately, health care reform should "encourage a shift from episodic, segmented care toward integrated patient-centered care ... even for our most complex older patients," they said.

Dr. Walke and Dr. Tinetti are in the division of geriatrics at Yale University, New Haven, Conn. Dr. Tinetti is also in the department of chronic disease epidemiology at Yale. They reported no financial conflicts of interest. These remarks were taken from their invited commentary accompanying Dr. Hung’s report (JAMA Intern. Med. 2013 April 22 [doi:10.1001/jamainternmed.2013.493]).