The effect of a physician assistant on the hospitalization of nursing home residents.
OBJECTIVE
To describe the impact of regular visits to a nursing home by a gerontologist physician assistant (PA) on the hospitalization and medical costs of patients.


METHODS
A 6-year case series (1992-1997) incorporating events before and after introduction of a PA in May 1994. The PA visited the nursing home 3 to 4 times per week, provided nearly all of the acute medical care, and alternated routine visits with supervising physicians.


METHODS
A 92-bed teaching nursing home in central Georgia.


METHODS
Demographics of the nursing home population; hospitalizations of residents, including major diagnosis and length of stay; number and site of all resident deaths; costs of physician and PA services and hospital costs.


RESULTS
After the introduction of the physician assistant, the number of annual hospital admissions fell by 38.0%, and the total number of hospital days per 1000 patient years fell by 68.6% (from 4170 in 1992 to 1310 in 1997). The number of nursing home visits increased by 62.1%. Annual Medicare-allowed charges for MD and PA services increased by $22,304, but this was more than offset by a decline in hospital DRG reimbursements of $96,043.


CONCLUSIONS
The introduction of regular visits to nursing home patients by a physician assistant can reduce hospitalization and medical costs of these frail older people.
Ackermann
R J
RJ
Department of Family and Community Medicine, Mercer University School of Medicine, and the Medical Center of Central Georgia, Macon, USA.
Kemle
K A
KA
D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D005260:Female; D016330:Frail Elderly; D005853:Geriatrics; D006760:Hospitalization; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D006278:Medicare / Q000191:economics; D009026:Mortality; D009735:Nursing Homes / Q000191:economics; D010823:Physician Assistants / Q000191:economics; D014481:United States