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A Swedish model for coordinating care of elderly people with complex needs


Images of Jönköping County.

A case study published by the Commonwealth Fund discusses Sweden’s “Esther Model” of caring for elderly patients with complex needs.

The authors note, by way of introduction:

“Elderly patients with complex care needs may receive services from multiple specialists, as well as primary care physicians. In addition, they may visit emergency departments, have frequent hospitalizations and post-hospital rehabilitations, and receive long-term care services at their home or in nursing facilities. Jönköping County, in Sweden ,focused on improving care coordination and the experiences of elderly patients through the ‘Esther Model.”‘

“The Esther model began in the late 1990s, originally as a three-year project. Founder Mats Bojestig, then head of the medical department of Höglandet Hospital, in Nässjö, used the negative experiences of an elderly patient, known as ‘Esther,’ as inspiration.”

As for its value as an example for America, the researchers write:

“The Esther Model developed as a voluntary collaborative effort in a small region that allowed for face-to-face meetings among all care-providing organizations. It is difficult to envision the model exported in its entirety to more complex settings. Nevertheless, many of its strategies are applicable well beyond a subregion of a Swedish county. In fact, cousins of the Esther approach are now operating elsewhere in Sweden, and replication is occurring in locations in other countries as well.

“The problems that the Esther model addresses certainly exist in the United States, where the care chain involves multiple provider organizations and payers with conflicting financial incentives. Establishing Esther or a similar model in the U.S. might be most feasible in places where single organizations are responsible for multiple levels of care or where hospitals serve reasonably well-defined geographic regions. Mechanisms that consolidate economic and medical responsibilities for patients, like accountable care organizations, would likely facilitate adoption of the model, as would financial incentives that deter practices that are harmful to patients and wasteful of resources, like unnecessary hospital readmissions. Adoption also might be aided by continuing to survey patients and caregivers about the care they are receiving.”

To read the (fascinating) study, please hit this link.

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