Hospital-at-Home: Bruce Leff and Tacara Soones
episode
GeriPal - A Geriatrics and Palliative Medicine Podcast
50 min
3 speakers
2 chapters
transcribed 8 hours ago
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What is the main topic discussed in this episode?
Welcome to the Jerry Pal podcast. This is Eric Guadera. This is Alex Smith. And Alex, who do we have with us today?
Today, we are delighted to welcome to the Jerry Pal podcast Takara Soons, who is a geriatrician. She trained at UCSF for geriatrics fellowship. After that, she was at faculty at Mount Sinai for a number of years and now is associate professor at MD Anderson in Texas and is the lead of the hospital at home program there called Care and Monitoring at Home. Takara, welcome to GeriPal.
Thank you so much for having me.
And we're delighted to welcome Bruce Leff, who is also a geriatrician and professor of medicine and director of the Center for Transformative Geriatric Research and has been studying hospital at home since the mid-90s. He's at Johns Hopkins in Baltimore, Maryland. Welcome to the GeriPal podcast, Bruce. Great to be here, guys.
I'm not sure how Hospital at Home slipped through 300 podcasts, and this is our first one, but I'm super excited because we're going to be talking about Hospital at Home today. But before we do, Bruce, do
you have the song request? I would love to hear Homeward Bound, Paul Simon. Great tune. Very, very much on point.
Yeah, I usually ask more about why you chose that song, but
this seems very on point.
I'm sitting in a railway station Got a ticket for my destination On a tour of one night stands My suitcase and guitar in hand And every stop is neatly planned For a poet and a one-man band Homeward bound I wish I was homeward bound. Home where my thoughts escape in. Home where my music's playing. Home where my love lies waiting silently for me.
That was fun. A lot of fast court changes there. Well done. Good challenge. Love it. Thank you.
Thanks. Okay. We are going to take our time machine. We're going to go back three decades to the early 90s or somewhere in the 90s. Bruce, how did you start getting interested in hospital at home at that time?
Yeah, it's a great question. Thanks for pitching it. So, you know, I trained at Hopkins. We had since the late 70s, a home based primary care program. So that's focused on older adults who are too frail to get into clinic. And we would provide ongoing longitudinal care to them in the home, much like the Mount Sinai visiting doctors programs and other programs like that. In that clinical experience, we saw a lot of older adults who would develop acute illness, often exacerbations. of their chronic conditions and it was not uncommon for them to absolutely refuse to go to the hospital. I remember as a resident taking care of folks with MI at home, pneumonia at home, COPD exacerbations at home because they would absolutely refuse to go to the hospital because they had been in their minds poorly treated or had bad experiences there.
On the flip side, I think as geriatricians, I know for myself, You know, one of the more difficult clinical decisions I face on an irregularly irregular basis is when I'm seeing people in clinic or in the home, they are acutely ill, I think I could get them to hospital to treat an acute illness. And I wonder whether sending them to a hospital would actually cause them more harm than good. You know, the pneumonia could get treated, but I think geriatricians actually were well aware of iatrogenic complications of care and quality gaps even well before the IOM reports of the late 1990s and the like. So delirium and functional decline and everything that we now call the hospital-associated disability syndrome, which your colleague Ken Kavinsky popularized in a great JAMA piece.
So those were some of the things that got us to think about hospital at home back in the late 80s, early 90s. And then I started working on it when my mentor, John Burton, convinced the Hartford Foundation program officer, Donna Regan Strife, to start to fund that and to think about actually developing that model. So that all started back in the mid-90s. And I could certainly talk about the details of that. But that's where the idea really germinated from.
How did we get to where we are now? What were some of the big changes that led us to kind of where we are now?
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Chapters
2 chaptersSpeakers
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