Key elements of high-quality primary care for vulnerable elders

Abstract

With the impending surge in the number of older adults, primary care clinicians will increasingly need to manage the care of vulnerable elders. Caring for vulnerable elders is complex because of their wide range of health goals and the interdependence of medical care and community supports needed to achieve those goals. In this article, we identify ways a primary care practice can reorganize to improve the care of vulnerable elders. We begin by identifying important outcomes for vulnerable elders and three key processes of care (communication, developing a personal care plan for each patient, and care coordination) needed to achieve these outcomes. We then describe two delivery models of primary care for vulnerable elders--co-management, and augmented primary care. Finally, we discuss how the physical plant, people, workflow management, and community linkages in a primary care practice can be restructured to better serve these patients.

Fig. 1

Conceptual framework. Italicized words represent key domains of structure, processes, and outcomes of primary care for vulnerable elders. The arrow refers to the direction of causation, and the words “chain of effect” indicate a linked relationship between structure and process, and process and outcomes. *For example: exam room layout to accommodate wheelchairs/walkers, multiple individuals; equipment that facilitates transfer from chair to exam table.