{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T16:52:24Z","timestamp":1785862344177,"version":"3.56.0"},"reference-count":28,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"unspecified","delay-in-days":33,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Fam Med Com Health"],"accepted":{"date-parts":[[2026,7,18]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>Fragmented care in older adults often results in duplicated testing, delayed decision-making and unclear clinical responsibility. These challenges are particularly pronounced in community and home-based primary care settings, where multiple providers contribute to care without formal coordination structures. Although comprehensive multidimensional geriatric evaluation is recommended, its complexity limits routine implementation. This article proposes a pragmatic framework integrating assessment of daily functioning, cognitive screening, mood assessment and mobility evaluation with targeted laboratory testing guided by clinical findings. A central principle of this model is clinical accountability, defined as the responsibility of the clinician who performs assessment and interprets findings to integrate diagnostic results into patient management and follow-up. In this framework, accountability refers specifically to responsibility for documenting findings, initiating appropriate follow-up evaluation and ensuring communication of clinically significant results. By linking brief multidimensional assessment, problem-oriented testing and explicit responsibility for follow-up, this practice-informed communication offers a pragmatic, adaptable approach for family physicians and community-based clinicians working in fragmented care environments. It is presented as a practice-informed proposal rather than a validated framework, consensus statement or guideline.<\/jats:p>","DOI":"10.1136\/fmch-2026-004209","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T15:51:58Z","timestamp":1785858718000},"page":"e004209","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical accountability in fragmented primary care for older adults: a practical framework for minimal multidimensional assessment and targeted testing in community and home-based settings"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3108-9074","authenticated-orcid":false,"given":"Joomong","family":"Park","sequence":"first","affiliation":[{"name":"Primary Care Division, Sacheon City Public Health Center, Sacheon, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"2026080305101582000_14.3.e004209.1","first-page":"355","article-title":"Care fragmentation, quality, and costs among chronically ill patients","volume":"21","author":"Frandsen","year":"2015","journal-title":"Am J Manag Care"},{"key":"2026080305101582000_14.3.e004209.2","doi-asserted-by":"crossref","unstructured":"Stuck AE , Iliffe S . Comprehensive geriatric assessment for older adults. BMJ 2011;343. doi:10.1136\/bmj.d6799","DOI":"10.1136\/bmj.d6799"},{"key":"2026080305101582000_14.3.e004209.3","doi-asserted-by":"crossref","unstructured":"Ellis G , Whitehead MA , O\u2019Neill D , et al . Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev 2011;CD006211. doi:10.1002\/14651858.CD006211.pub2","DOI":"10.1002\/14651858.CD006211.pub2"},{"key":"2026080305101582000_14.3.e004209.4","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/59.5.M473"},{"key":"2026080305101582000_14.3.e004209.5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2012.04188.x"},{"key":"2026080305101582000_14.3.e004209.6","doi-asserted-by":"publisher","DOI":"10.1007\/s40520-019-01183-w"},{"key":"2026080305101582000_14.3.e004209.7","doi-asserted-by":"crossref","first-page":"2145","DOI":"10.1016\/S0140-6736(15)00516-4","article-title":"The World report on ageing and health: a policy framework for healthy ageing","volume":"387","author":"Beard","year":"2016","journal-title":"The Lancet"},{"key":"2026080305101582000_14.3.e004209.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60240-2"},{"key":"2026080305101582000_14.3.e004209.9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1963.03060120024016"},{"key":"2026080305101582000_14.3.e004209.10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2005.53221.x"},{"key":"2026080305101582000_14.3.e004209.11","doi-asserted-by":"publisher","DOI":"10.1046\/j.1532-5415.2003.51465.x"},{"key":"2026080305101582000_14.3.e004209.12","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3956(75)90026-6"},{"key":"2026080305101582000_14.3.e004209.13","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3956(82)90033-4"},{"key":"2026080305101582000_14.3.e004209.14","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1991.tb01616.x"},{"key":"2026080305101582000_14.3.e004209.15","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/80.9.896"},{"key":"2026080305101582000_14.3.e004209.16","doi-asserted-by":"publisher","DOI":"10.1517\/14740338.2013.827660"},{"key":"2026080305101582000_14.3.e004209.17","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198812293192604"},{"key":"2026080305101582000_14.3.e004209.18","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-0009.2005.00409.x"},{"key":"2026080305101582000_14.3.e004209.19","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.8531"},{"key":"2026080305101582000_14.3.e004209.20","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMhpr0706165"},{"key":"2026080305101582000_14.3.e004209.21","unstructured":"World Health Organization . Integrated care for older people (ICOPE): guidance for person-centred assessment and pathways in primary care. Geneva WHO; 2019."},{"key":"2026080305101582000_14.3.e004209.22","unstructured":"Multimorbidity: clinical assessment and management. NICE guideline [NG56]. London NICE; 2016."},{"key":"2026080305101582000_14.3.e004209.23","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2018.0738"},{"key":"2026080305101582000_14.3.e004209.24","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.27.3.759"},{"key":"2026080305101582000_14.3.e004209.25","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2014.0041"},{"key":"2026080305101582000_14.3.e004209.26","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12419"},{"key":"2026080305101582000_14.3.e004209.27","doi-asserted-by":"crossref","DOI":"10.1136\/fmch-2025-003721","article-title":"Adoption of the Reference Framework for Preventive Care for Older Adults: a study of primary care physicians","volume":"14","author":"Zhong","year":"2026","journal-title":"Fam Med Community Health"},{"key":"2026080305101582000_14.3.e004209.28","doi-asserted-by":"crossref","DOI":"10.1136\/fmch-2024-003234","article-title":"Time to care: the lived experience of receiving care from a primary care service for people with frequent hospital admissions","volume":"14","author":"McGowan","year":"2026","journal-title":"Fam Med Community Health"}],"container-title":["Family Medicine and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/fmch-2026-004209","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T15:52:00Z","timestamp":1785858720000},"score":1,"resource":{"primary":{"URL":"https:\/\/fmch.bmj.com\/lookup\/doi\/10.1136\/fmch-2026-004209"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":28,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,8,3]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/fmch-2026-004209"],"URL":"https:\/\/doi.org\/10.1136\/fmch-2026-004209","relation":{},"ISSN":["2305-6983","2009-8774"],"issn-type":[{"value":"2305-6983","type":"print"},{"value":"2009-8774","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}