Department of Medicine

University of Pittsburgh

GIM News
Donna L. Bishop, Editor

Next issue:
August 2011

Submission deadline:
June 17, 2011

E-mail: bishopdl@upmc.edu

Care Provided by the UPMC Supportive Services Program

In January 2011, the UPMC Supportive Services Program began to provide support to patients who are at risk for hospital readmissions and decreased quality of life and are in the program called UPMC for Life. Support includes maintaining the patients' functional status and avoidance of secondary complications, ensuring that the patients' treatment plans match their values and goals, and promoting quality of life by helping treat the patients' symptoms.

All general and internal medicine patients who are 65 years or older, are admitted to UPMC Presbyterian/Montefiore Hospitals, and have UPMC for Life insurance are eligible to be screened by the Supportive Services Program nurse liaison for geriatric or palliative care needs. If the screening indicates that the patient has these needs, the program nurse asks the attending inpatient physician for permission to conduct a consultation. The nurse then completes a full assessment of the patient and either a geriatric physician or a palliative care physician sees the patient. Any treatment recommendations are given to the attending inpatient physician by the Supportive Services Program team. The team then continues to follow the patient throughout his or her hospital stay, and the nurse follows the patient up to 30 days after hospital discharge.

The Supportive Services Program nurse works in collaboration with the hospital and the UPMC Health Plan's case managers to facilitate coordination of care and to minimize acute care hospital admissions and subsequent nursing home admission.

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