This is one of the three papers presented at the Association of Directors of Geriatrics Academic Programs symposium at the American Geriatrics Society annual meeting in 2007. An accompanying editorial and commentary are included in this brief series.
Defining the Domain of Geriatric Medicine in an Urban Public Health System Affiliated with an Academic Medical Center
Article first published online: 15 SEP 2008
© 2008, Copyright the Authors. Journal compilation © 2008, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 56, Issue 10, pages 1802–1806, October 2008
How to Cite
Callahan, C. M., Weiner, M. and Counsell, S. R. (2008), Defining the Domain of Geriatric Medicine in an Urban Public Health System Affiliated with an Academic Medical Center. Journal of the American Geriatrics Society, 56: 1802–1806. doi: 10.1111/j.1532-5415.2008.01941.x
- Issue published online: 1 OCT 2008
- Article first published online: 15 SEP 2008
- geriatric medicine;
- healthcare system;
- physician manpower
The American Geriatrics Society has recommended a reexamination of the roles and deployment of providers with expertise in geriatric medicine. Healthcare systems use a variety of strategies to maximize their geriatric expertise. In general, these health systems tend to focus geriatric medicine resources on a group of older adults that are locally defined as the most in need. This article describes a model of care within an academic urban public health system and describes how local characteristics interact to define the domain of geriatric medicine. This domain is defined using 4 years of data from an electronic medical record combined with data collected from clinical trials.
From January 2002 to December 2005, 31,443 adults aged 65 and older were seen at any clinical site within this healthcare system. The mean age was 75 (range 65–105); 61% were women; 35% African American, and 2% Hispanic. The payer mix was 80% Medicare and 17% Medicaid. The local geriatric medicine program includes sites of care in inpatient, ambulatory, nursing home, and home-based settings.
By design, this geriatric medicine clinical practice complements the care provided to older adults by the primary care practice. Primary care physicians tend to cede care to geriatric medicine for older adults with advanced disability or geriatric syndromes. This is most apparent for older adults in nursing facilities or those requiring home-based care. There is a dynamic interplay between design features, reputation, and capacity that modulates volume, location, and type of patients seen by geriatrics.