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American Academy of Home Care Physicians
Promoting the art, science and practice of medicine in the
home.
2000 Vol. 12 No. 4
Issn# 1049-0028
Annual Scientific Meeting
By: C. Gresham Bayne, MD and Constance F. Row, FACHE
Perhaps it was the growing interest in house calls, or the need
for physicians to understand the complexities of home care, or
former HCFA Director Bruce Vladeck giving the opening talk at
the AGS morning meeting. Whatever it was, the AAHCP Annual Scientific
Meeting filled the hall with people sitting on the floor, standing
in the aisles, and asking for more handouts. With the program
developed by AAHCP Scientific Meeting Chair Ziad Haydar, MD, the
program focused on predictions about home care in the 21st Century.
For those who were not able to attend, or who did not get the
speaker's handouts due to unexpected demand, here are some notes
from the excellent presenters. Tapes of the session are available
from the American Geriatrics Society at 212/308-1414
"Admit to Homecare, Discharge to Hospital-Education for A
Change in Culture." Knight Steel, MD, Endowed Professor of
Geriatrics, New Jersey Medical School; and Director, The Homecare
Institute, Hackensack University Medical Center.
Calling for the Academy and "believer" physicians to
continue the quest for revolutionary change to include home care
medicine, Dr. Steel cautioned against tactics unlikely to produce
change, and shared his views of how to influence decision-makers
to support the cause.
*It's the incentives, not the goodwill or "velocity of finger-pointing"
or "chorus of "shoulds" that will effect change.
*Never present requests for your program as requests, but as solutions
to a problem (incentive in disguise). Consider what matters to
those whom you are trying to get to support your program-CEO's,
Department Chairs, etc. Money, prestige, satisfying the RRC, political
constituencies to support the hospital or medical school.
*Home care "should not be portrayed as a charming, quaint
service."Without an academic base," there is no future
for this endeavor." Critical thinking, clinical investigation
is needed to give a scientific answer, for example, on whether
given home visits are of acceptable quality, and necessary or
sufficient.
*"Our task as..a professional organization is to define the
incentives for a home care system," specifically better care
at less cost. Reimbursement systems need to be "sculpted"
to these programs. Only with an evidence base will be we able
to convince payors to change.
*We are "scripting a revolution in American medicine"
and "I believe the people are celebrating." "We
will have our revolution and it will prevail because it will be
based on science and be designed to fulfill our obligation as
physicians to place the needs of our patients first and their
well-being above all else. We will discharge our patients to hospitals
when appropriate and admit them to a sophisticated humanistic
care system which delivers services where they reside"
The objectives and further details are listed in the booklet "A
Home Care Program for Every Medical School, the Expansion of Home
Care into Academic Medicine," Committee for the Design of
a Home Care Curriculum, The John A. Hartford Foundation, 2000.
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