| Description |
Introduction: Older adults with complex medical needs are difficult to manage within various care settings, particularly in rural areas. The purpose of this project was to assess if Sweetwater County WY would benefit from an intervention aimed at improving care coordination in the form of a managed care model. Objective: A quality improvement initiative was undertaken through a multi-step process; a) a community needs assessment to gain a better understanding of barriers and existing supports (facilitators) related to caring for older adults with complex medical needs, b) the development of a list of county specific recommendations, c) the proposal of a managed care model for Sweetwater County based on findings obtained through the community needs assessment. Methods: Quantitative and qualitative data were collected through the analysis of semi structured survey responses from healthcare providers, and open-ended interviews with representatives from various healthcare organizations within the county. Results: Analysis of survey and interview data revealed that Sweetwater County needed improvement in several critical areas, 19 of 37 healthcare providers queried completed surveys. A total of 12 interviews were conducted. Survey responses included; 89% identified inadequate financial support as a barrier. 74% selected that transitions of care needed improvement, 84% identified home health services as a facilitator, and 58% chose that if available they would utilize palliative care services. Comments from the interviews were organized into the following categories; a) barriers to care, b) facilitators for care, and c) transitions of care. Barriers included comments related to the national health system structure, and financial reimbursement model. State Adult Protective Services were inadequate, poor local resources, collaboration, access, and rural health were barriers to care. Improvement was needed in regard to collaboration, retention, and access to case management. On a patient level safety, support and financial resources were barriers. Facilitators included comments that personal relationships improved communication and collaboration across agencies. The local hospital primary care network, and more providers willing to offer services to Medicare and Medicaid recipients were assets. Provider retention has improved from what it was in the past. On the patient level access to reliable transportation, local resources, financial support, and advance care planning improved the patient experience. Themes identified from comments about transitions of care included; communication, collaboration, resources and transportation. Discussion: The needs assessment identified the necessity for improvement of care coordination in Sweetwater County. It was concluded that a more focused assessment about the patient demographic and healthcare utilization would help to determine the most feasible and sustainable managed care model for the area. A model should be implemented along with county specific improvement initiatives to support the model. One model cannot be recommended over the other based on this assessment, however snapshots of three models were provided; Chronic Care Management Program, Guided Care, and Patient Centered Medical Home. Coordination of care is dependent on many factors, and requires a unique synergy between all agencies involved. While models provide a framework they need to be adapted to work for each individual community. |
