Managed primary care of nursing home residents.
OBJECTIVE
To measure the rates of hospital use and mortality of nursing homes residents who received their primary care from nurse practitioner-physician teams.


METHODS
A cohort study.


METHODS
Thirty nursing homes in Southern California.


METHODS
Older, long-term residents of nursing homes enrolled in a Medicare HMO (n = 307).


METHODS
Primary care by an accessible interdisciplinary team supported by clinical guidelines, continuous quality improvement techniques, and increased availability of clinical services at the nursing homes.


RESULTS
The residents (mean age 83.5 years, 69.0% women) had a high prevalence of dementia (83.5%) and functional disability (87.2% were dependent in two or more activities of daily living). About half (50.8%) expressed a preference for "no hospitalization and no resuscitation." Compared with other nursing homes populations, this cohort experienced a lower annual rate of hospital use (518 days/1000 residents) and a similar rate of mortality (23.8%).


CONCLUSIONS
Integration of the efforts of physicians, nurse practitioners, and nursing home staff can lead to low rates of hospital use by nursing home residents. The effects on residents' quality of life and mortality require further study.
Joseph
A
A
Department of Continuing Care Services, Southern California Medical Group, San Diego 92120, USA.
Boult
C
C
D000203:Activities of Daily Living; D016223:Advance Directives / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000379:methods; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017146:Models, Organizational; D009026:Mortality; D009735:Nursing Homes / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D010348:Patient Care Team; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards