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Part I Introduction to Nutrition Care in Older Adults

RDNs can work with home infusion companies and home health agencies providing home intravenous therapy, including antibiotic therapy, total parenteral nutrition, peripheral parenteral nutrition, and hydration therapy. Diseases commonly requiring infusion therapy include infections that are unresponsive to oral antibi- otics, cancer and cancer-related pain, dehydration, gas- trointestinal diseases or disorders that prevent normal functioning of the gastrointestinal system, and more. Other conditions treated with specialty infusion thera- pies may include cancers, congestive heart failure, Crohn’s disease, hemophilia, immune deficiencies, multiple sclerosis, rheumatoid arthritis, and more.

Patient-Centered Medical Home and the Triple Aim

As stated earlier in the chapter, there are three aims that should be pursued in the quest to improve health care systems in the United States:

●

improving the experience of care for each individual;

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improving the health of the populations served; and

● reducing per capita costs of health care.

All care-delivery strategies (including medical homes or the acountable care organizations) need goals to generate positive outcomes in all three aspects of what is known as the Triple Aim. The resident-driven medical home helps organize primary care, stressing care coordination and communication to create care that is “what patients want it to be.” This can lead to higher quality, lower costs, and improved care for both residents and staff (45-48). The Agency for Healthcare Research and Quality (AHRQ) defines a medical home not simply as a place but also as a model of the organization of primary care that delivers the core functions of primary health care (45,46).

The medical home encompasses three functions

and attributes: ●

Comprehensive care that is accountable for meeting the majority of each patient’s physical and mental health care needs, including preven- tion and wellness, acute care, and chronic care. A team of care providers might include physicians, advanced practice nurses, physician assistants, nurses, pharmacists, RDNs, social workers, edu- cators, and care coordinators. Some medical home practices may build virtual teams linking patients to providers and services in their communities (45).

● ●

Patient-centered care with an orientation toward the whole person. Recognizing that patients and families are core members of the care team, medical home practices ensure that they are fully informed partners in establishing care plans and seek to understand and respect each patient’s unique needs, culture, values, and preferences. The medical home practice actively supports patients in learning to manage and organize their own care at the level the patient chooses.

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Coordinated care across all elements of the broader health care system, including specialty care, hospitals, home health care, and community services and supports. Such coordination is partic- ularly critical during transitions between sites of care, such as when patients are being discharged from the hospital. Medical home practices also excel at building clear and open communication among patients and families, the medical home, and members of the broader care team (45).

Accessible services delivered with shorter waiting times for urgent needs, enhanced in-person hours, around-the-clock telephone or electronic access to a member of the care team, and alternative methods of communication such as e-mail and telephone care. The medical home practice is responsive to patients’ preferences regarding access (45).

●

Quality and safety demonstrated by using evi- dence-based medicine and clinical decision– support tools to guide shared decision-making with patients and families, engaging in perfor- mance measurement and improvement, measuring and responding to patient experiences and patient satisfaction, and practicing population health management. Publicly sharing robust quality and safety data and improvement activities is also an important marker of a system-level commitment to quality. Utilizing electronic medical records and making meaningful use of data (ie, assessing diabetes, making appropriate referrals, and devel- oping initial interventions and then monitoring/ evaluating those interventions) can be a considerable role for the RDN. An example of providing quality data is documenting achieved outcomes after evaluating the number of clients with diabetes having an elevated HgA1c who par- ticipated in a certified diabetes education program (49).

The AHRQ recognizes the central role of health infor- mation technology (HIT) in successfully operationaliz- ing and implementing the key features of the medical home (49). Additionally, the AHRQ notes that building