Perspective: Transforming Chronic Care for Older Persons

Boult, Chad MD, MPH, MBA; Christmas, Colleen MD; Durso, Samuel C. MD, MBA; Leff, Bruce MD; Boult, Lisa B. MD, MPH, MA; Fried, Linda P. MD, MPH

Academic Medicine:
doi: 10.1097/ACM.0b013e3181782b14
Population Health
Abstract

The size and impending morbidity of the aging baby boom generation could soon overwhelm the U.S. health care system. Transforming chronic care for older persons to avert this calamity will require rapid increases in the number of physicians who are skilled in providing chronic care and prompt adoption of new models for providing high-quality, cost-effective chronic care.

The authors propose a new approach for attaining these objectives, recommending that today’s leaders of academic medicine help transform geriatrics into a collaborative discipline of clinicians with advanced skills in leading educational, organizational, and research-related initiatives; that they support the collaboration of geriatrics with primary care and specialty disciplines in preparing physicians to practice effectively in new models of chronic care for older persons; and that they energetically promote rigorous training in chronic care at all levels of medical education.

Implementing this strategy would require firm commitment by the Association of American Medical Colleges, specialty boards, accrediting organizations, academic institutions, the Centers for Medicare and Medicaid Services, legislators, and business leaders. Although garnering such support would be challenging and controversial, this approach could leverage the expertise of geriatric educator–leaders to help transform chronic care in the United States and to make high-quality, cost-effective chronic care accessible to most chronically ill Americans within 20 years.

Author Information

Dr. C. Boult is director, Roger C. Lipitz Center for Integrated Health Care, Department of Health Policy and Management, Bloomberg School of Public Health, and professor of public health, with joint appointments in medicine and nursing, Johns Hopkins University, Baltimore, Maryland.

Dr. Christmas is director of residency education, Bayview Medical Center, and assistant professor of medicine, Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Dr. Durso is clinical director, Division of Geriatric Medicine and Gerontology, and associate professor of medicine, Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Dr. Leff is associate professor of medicine, Division of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, with a joint appointment in the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.

Dr. L. Boult is assistant professor of medicine, Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Dr. Fried is dean, Mailman School of Public Health, and De Lamar Professor of epidemiology, Columbia University, New York, New York.

Please see the end of this article for information about the authors.

Correspondence should be addressed to Dr. C. Boult, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 693, Baltimore, MD 21205; telephone: (410) 955-6546; fax: (410) 955-0470; e-mail: (cboult@jhsph.edu).

© 2008 Association of American Medical Colleges