May 23/30, 2012

The Journey Across the Health Care (Dis)Continuum for Vulnerable PatientsPolicies, Pitfalls, and Possibilities

Author Affiliations

Author Affiliations: Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.

JAMA. 2012;307(20):2157-2158. doi:10.1001/jama.2012.5566

Older adults with hip fracture and multiple chronic conditions illustrate the challenges facing vulnerable patients as they move through the health care system.1 Their journey highlights recent policies that both facilitate and impede attempts to provide appropriate care and suggest gaps that need to be filled to ensure better care and outcomes.

The journey through the health care system for most patients with serious injuries or illnesses begins in the emergency department (ED). EDs are structured to rapidly manage and treat large numbers of patients. The necessary focus on speed, however, accelerated when the Joint Commission created standards to address overcrowding, and is in conflict with the careful deliberations needed to care for complex patients with multiple acute and chronic conditions. The chaotic and unfamiliar environment can exacerbate problems such as pain and delirium.2

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