Cheryl Phillips, M.D, AGSF, is the senior program consultant for the John A Hartford Foundation’s Age-Friendly Health Systems initiative and discusses the 4Ms. What Matters, Medication, Mentation and Mobility and how these concepts interface with person-centered care planning for persons with and at risk for multiple chronic conditions. Dr. Phillips describes the administration’s policy changes with the Agency for Healthcare Research and Quality and how the John A. Hartford Foundation will continue to promote person-centered care for the nations aging population

The Centers for Medicare & Medicaid Services released a new Age Friendly Hospital Measure  designed to improve the care and outcomes of older hospitalized adult patients.
https://www.facs.org/quality-programs/accreditation-and-verification/geriatric-surgery-verification/cms-age-friendly-hospital-measure/

Institute for Healthcare Improvement Patient and Family Resources on Age-Friendly Care https://www.ihi.org/library/tools/patient-safety-essentials-toolkit

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In this edition of the MCCRC Podcast, Dr. Kim Kuebler sits down with Richard Knight to discuss the Patient Perspective for those with Kidney Disease.

Hear Richard's key take away’s, specific information that would have helped him to better understand how his hypertension impacted upon his kidney function, talking about the missing links in the collaborative medical management of patients with kidney disease, and much more!

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Arlene Bierman MD, MS, Brittany Watson MD, MPH and Jane Pederson MD, MS discuss the recent JAMA online publication Person-Centered Care Planning for People Living with or at Risk for Multiple Chronic Conditions. This paper describes a qualitative study using theme analysis from responses following a Request for Information (RFI) published in the Federal Register soliciting input on PCCP, posted by the Agency for Healthcare Research and Quality (AHRQ) in 2022. Responses were analyzed between January 2023 and February 2024.

The researchers identified 9 themes: (1) suboptimal quality of care; (2) person-centered, goal-concordant care; (3) multidisciplinary team–based care and care coordination; (4) prevention across the life course; (5) digital health solutions; (6) workflow; (7) education and self-management support; (8) payment; and (9) achieving community, health system, and payer goals.

The information collected from this study are used to gain momentum in the AHRQ’s initiative on Person-Centered Care Planning for People with MCC. This data was used to solicit input from multidisciplinary experts, patients and policy stakeholders at the recent AHRQ Summit to determine next steps in promoting comprehensive care for the nation’s largest patient population – those living with MCC.

LINK TO FULL ARTICLE: https://www.nursingoutlook.org/article/S0029-6554(24)00166-0/abstract?dgcid=raven_jbs_etoc_email

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A link to the slides mentioned in the podcast: https://hcanys.org/doclink/kuebler-medication-safety/eyJ0eXAiOiJKV1QiLCJhbGciOiJIUzI1NiJ9.eyJzdWIiOiJrdWVibGVyLW1lZGljYXRpb24tc2FmZXR5IiwiaWF0IjoxNzMzNDIwOTE0LCJleHAiOjE3MzM1MDczMTR9.Xg5H1OS1UAio4gUrdriWHmecDx9uMOC-ZmB2Y-Rv9I8

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In the sixth edition of the MCCRC Podcast, Dr Kim Kuebler sits down with Dr. Eduardo Bruera to discuss palliative care in and how it is being used in the primary care setting for those patients living with non-reversible, symptomatic chronic conditions.

Here is a link to the reference Dr. Bruera used in this podcast: https://www.nursingoutlook.org/article/S0029-6554(24)00166-0/abstract?dgcid=raven_jbs_etoc_email 

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In the fifth edition of the MCCRC Podcast, Dr. Kim Kuebler sits down with Dr. Paul Ciechanowski talks about the benefits of integrated behavioral health models in primary care, why integrated care is a preferable model to hiring psychiatrists or social workers as part of a co-located model, and much more.

Here are links to the references Dr. Ciechanowski used in the podcast:

Clinical inertia:

https://escholarship.org/content/qt7fd7r9r5/qt7fd7r9r5.pdf

Two clinical trials that support collaborative care by research groups:

https://jamanetwork.com/journals/jama/fullarticle/198486

https://www.nejm.org/doi/full/10.1056/NEJMoa1003955

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In the fourth edition of the MCCRC Podcast, Dr. Kim Kuebler sits down with Dr. Irina Koyfman to talk about Chronic Care Management (CCM), getting in depth on what CCM really is, why specialists should consider doing CCM, and the future of CCM. Visit The Multiple Chronic Conditions Website here: https://multiplechronicconditions.org/

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In the third edition of The MCCRC Podcast, Dr. Kim Kuebler sits down with Dr. Matthew Sorenson to talk about how the human body is impacted by chronic conditions, the different types of cells in the immune system, and the factors impacting immune health. Visit The Multiple Chronic Conditions Website here: https://multiplechronicconditions.org/

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In this second edition of The MCCRC Podcast, Dr. Kim Kuebler sits down with Dr. Glenna Crooks to talk about her most recent research on helping overloaded people remaining in the workforce, along with her most recent book "The NetworkSage: Realize Your Network Superpower."

Order "The NetworkSage: Realize Your Network Superpower" here: https://www.amazon.com/NetworkSage-Realize-Your-Network-Superpower/dp/1532029624

The MCCRC Podcast EP #2: Dr. Glenna Crooks, PhD

Visit The Multiple Chronic Conditions Website here: https://multiplechronicconditions.org/

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In this first edition of The MCCRC Podcast, Dr. Kim Kuebler sits down with Dr. Julian L. Gallegos to talk about T2DM, Obesity, and Hypogonadism.

Visit The Multiple Chronic Conditions Website here: https://multiplechronicconditions.org/

The MCCRC Podcast EP #1: Dr. Julian L. Gallegos, PhD, MBA, FNP-BC, CNL, CMHE, FAUNA

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