A continuum of care for the inner city: assessment of its benefits for Boston's elderly and high-risk populations.
We describe an approach to health care in the inner city: a multidisciplinary system of physicians and mid-level practitioners that provides individualized care to chronically ill, elderly, homebound, and nursing-home residents of urban Boston who would otherwise be forced into an inappropriate reliance on teaching hospitals. Linked to four neighborhood health centers, three home-care programs, and a teaching hospital, and financially self-supporting except for the home-care component, the system cared for 3000 ambulatory, 280 homebound, and 358 nursing-home patients in the representative year described. In-hospital use, particularly hospital days, was reduced when judged by existing data for comparable (though not identical) populations. Based on stable physician practices, the system offers a workable approach to the related problems of care, manpower, and cost in the urban core.
D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration; D001900:Boston; D002908:Chronic Disease; D003151:Community Health Centers; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D005249:Fees and Charges; D005260:Female; D006299:Health Services for the Aged / Q000458:organization & administration; D006699:Home Care Services; D006760:Hospitalization; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D011203:Poverty; D011204:Poverty Areas