Healthcare Policy Innovations: Arthur Garson, MD


What the Grand-Aides program does is leverage
physicians and nurses so they can see sick people quicker and keep people who don’t
need to be in the emergency room at home. So a Grand-Aide is a certified nurse aid who’s
had training who has the characteristics of a good grandparent. Six Grand-Aides can work
with one nurse, leveraging that nurse six to one. Several years ago a very prominent
family physician said to me, “You know, about 50% of my patients could be taken care
of by a good grandparent.” Now that’s hyperbolic, but it made a pretty important
impression on me. A Grand-Aide is someone who’s nurturing, someone who’s caring, someone
who’s competent, someone who doesn’t fall apart when somebody’s sick, and that person
becomes a connector between the patient and family and the care team. The Grand-Aide goes
home the day or the day after discharge with a patient with a disease such as heart failure.
Turns out in heart failure, as much as 50% of the thirty-day readmissions are in the
first week, so the Grand-Aide visits every day for the first week. So very early on in the
experience at the University of Virginia there was a patient who the Grand-Aide went to see.
The Grand-Aide goes, goes through the protocol, and the patient is pale, sweaty, feeling bad,
and the Grand-Aide takes their hand held device and uses the video, HIPAA compliant, back
to the supervisor. Supervisor says, “No, you don’t look so good. Let’s go do your
medication reconciliation.” The Grand-Aide starts up the video from the hand held device,
puts all of the medication that the patient is supposed to be taking coming home at one
point on the table, and they check off one by one, “that’s fine.” Then the Grand-Aide
gets everything else out of the medicine cabinet, puts that on the other side of the table and
says, “You’re not taking any of this are you?” And he said, “Well of course I am!”
Aha. There was the problem. The Grand-Aide and the supervisor were able to say “You know
what? Take only what you were supposed to take.” By the time the GrandAide got back
the next day, patient felt a whole lot better. A nurse can do that, the problem is it’s
very expensive and you may not be able to find the nurses. A Grand-Aide can absolutely
do this at a reduced cost. The patient gets helped in a number of ways, they get taken
care of at home, they get taken care of efficiently, but they still have absolute access to the
medical care team. Now the other people that are helped are the practitioners, the nurses,
the doctors, and the clinics and the emergency rooms and the hospitals. Six Grand-Aides report
to one nurse so the nurse is leveraged and the Grand-Aides are much less expensive than
a nurse. I’m Tim Garson and I believe that policy innovation can improve health.

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