Patient-centric medical home provides comprehensive, holistic care, support and access to community resourcesMountain View, Calif., October 23, 2012
-- El Camino Hospital continues its groundbreaking service to the community with the opening of its center aimed exclusively at providing a "patient-centered medical home" to patients 65 and older. The Senior Health Center
is designed to ensure access to fully integrated, comprehensive care so that seniors can remain healthy and independent as long as possible. The center represents a new approach to senior care and is one of the first of its kind in Northern California.Patrick Kearns, M.D.
, a longtime gerontologist and chronic care expert in the community, serves as the center's medical director and has been instrumental in its creation. "It is estimated that by the year 2020, Santa Clara County's population of adults over 65 will reach close to 300,000, nearly double what it is today, and these adults will be dealing with a wide array of chronic conditions like arthritis, diabetes and cardiovascular disease," states Dr. Kearns. "This makes it imperative to have this 'patient-centered medical home' model that offers a better way to help them manage their ongoing care."
The Senior Health Center's multidisciplinary team provides fully integrated care under the direction of board-certified internists and geriatricians who work directly with patients' current physicians to coordinate services at the center and in the community. Patients have the opportunity to select a primary care physician , if they do not already have one, and are also supported by an extensive care team – including a nurse coordinator, a nutritionist, a geriatric case worker, a pharmacist and other experts as needed.
In addition, the center supports patients with tools and techniques that help them stay involved in their health care management. One of those tools is a secure online patient portal tied to the patient's medical record. Through this portal, patients are able to communicate with their entire care team, receive test results, schedule appointments and keep track of their medical care. For some patients in the community, this could be the first time they have had all of their patient records stored in a central location.
Creating an extensive support network for older adults is a key piece of the medical home concept. "One of the key differences with the Senior Health Center is that we provide comprehensive care to the patient through an extensive care team, focus on wellness and independence and spend the time needed with each patient and their caregivers necessary to improve health," says Scott Farr, vice president of Continuum of Care, who works closely with Dr. Kearns. "Here, the patient comes first."
With so many physician practices full or unable to accept Medicare Part B Fee-for-Service patients, the center provides a primary care alternative for individuals over the age of 65. Seniors do not have to be a current or prior patient at El Camino Hospital to use the center. Patients can self-refer or be referred from a physician who does not take Medicare Part B.
So far patients have been thrilled with the new model of care. One recent patient wrote: "Dr. Kearns was outstanding! He was very thorough with my exam and very easy to talk to. Jodie, the clinical manager, was very thorough in explaining the Senior Health Center to us, and also answered any questions we had. We love it!"
Services Offered Through our "Patient-centered Medical Home"
The center ensures that both the medical and psycho-social needs of the patient are met. Services include not only the diagnosis and treatment of an immediate illness or injury, but also future risk assessment wellness planning, disease-specific health education, nutritional assessment, medication counseling and functional/social/psychological assessments.
For example, pharmacists and dietitians look carefully at each senior's prescription medications and monitor their diets. Case workers focus on finding out what sort of support they the patient needs at home, and whether there are relatives helping with care. If transportation to and from home is needed, El Camino Hospital's volunteer Road Runner service is an option.
The center also assists patients in understanding various Medicare plan options. By talking with staff, seniors can evaluate all of the plan options and discuss additions such as prescription drug coverage and supplemental packages.
Support for and Collaboration with Community Physicians
The Senior Health Center care team welcomes the opportunity to work with community physicians when they have a patient requiring more intense care management. The patient can be referred to the center, be assessed and managed through initial care planning and treatment, and then be returned to the community practice when mutually agreed. Several of these referrals have already yielded excellent benefit for both the patient and their primary care practice.
Medical Staff Dr. Patrick Kearns, Medical Director
In the past three decades, Dr. Patrick Kearns has worked extensively with Silicon Valley's aging population, as both a physician and an administrator at Santa Clara Valley Medical Center (SCVMC). At SCVMC, he served in leadership roles in chronic care management, diabetes care, inpatient management, clinical nutrition, primary care and intensive care. He also has been involved in numerous local and national initiatives and task forces in those key areas.
Dr. Martha Dorn
Dr. Martha Dorn has been a Bay Area physician for 20 years. She is board certified in Internal Medicine, Emergency Medicine, and most recently completed a fellowship in Geriatrics at Stanford University Medical Center. She has been on the faculty of The University of Rochester and at Stanford University Medical Center. She has served as the Medical Director of the Emergency Department of the VA Palo Alto Health Care Center, The Refugee Clinic at Valley Medical Center, and at The Willow Clinic, a multidisciplinary clinic in San Mateo County. She is published in peer reviewed journals, and has written articles for books, monographs, and book chapters on several clinical topics. She is a member of the American Geriatrics Society and a former Fellow of the American College of Emergency Medicine.
Dr. Eric Pifer, chief medical officer, El Camino HospitalDr. Eric A. Pifer
is a practicing physician who works with patients at the Senior Health Center. Dr. Pifer has received the American Medical Director of Information Systems Award for Excellence and the Alfred E. Stengel Health System Champion Award. He is widely published on the subject of health care informatics, and co-authored Improving Outcomes with Clinical Decision Support, a highly regarded resource for those in the health care industry.
Dr. Jessica YbarraDr. Jessica Ybarra
completed her fellowship in geriatrics at Stanford University's School of Medicine in 2012, and has been working with the elderly population for many years. She has seen patients both at the VA Hospital in Palo Alto and at the Terraces, a senior living facility in Phoenix. Dr. Ybarra is a member of the American Geriatrics Society and the American Academy of Family Physicians.
The Senior Health Center is located on the El Camino Hospital main campus in Mountain View, Calif. It is housed in the Cedar Pavilion at 2660 Grant Road, Suite F. Patients, caregivers and families can contact the Center Monday through Friday by calling 650-962-4360.