It is safe to say that CALTCM is a proponent of improving the quality of care in post-acute and long-term care (PA/LTC) and it is another to say that our members and our audience are the crème de la crème.  The inspiration to give our members and audience the opportunity to present their Best Practices was built on the knowledge that our members and facilities are making amazing changes in their own facilities to improve care every day. Our goal is simple, to improve care and to teach our members how to take quality to the next step.

Christine Mlot,MD trained at the University of California, Irvine and at the Long Beach VA Program in Internal Medicine. She has experience in geriatrics and rehabilitation medicine. She is also a member of AMDA. She is an Associates Clinical Professor at UCSD School of Medicine and a frequent lecturer on post-acute, managed care and physician role in the nursing facility.

The aging of kidneys has important implications for our patients as we choose treatments and consider the overall burden of care. As life expectancies are increasing worldwide there is an increase in our senior and elderly populations. At the pace we are going, the senior populations will comprise between 20 - 27 % of the total population by 2030 in most of the developed world. During 1995-2005 the adjusted point prevalence rates per million population of reported ESRD increased by 73% in the 75 + age group.

When I left my office internal medicine practice in 2005 to work full time in the SNF setting as a clinician and Medical Director, I was able to keep my previous on-call relationships with my colleagues.  However, the commitment to caring for my patients on the part of my colleagues, was a commitment to managing patient issues by phone or fax with the understanding that the ER would be the default position.  Specifically, there wasn’t a commitment to seeing patients on site for changes of condition or for seeing patients prior to being discharged to a lesser setting of care.  The latter would instead be done by facilities faxing a request for d/c home on current meds with appropriate DME and outpatient rehab referrals.  I would describe this system as working well for physician practices, but not optimally for the patient.