title: Primary care of long-stay nursing home residents: approaches of three health maintenance organizations.
abstract: OBJECTIVE
  To describe the innovative programs of three health maintenance organizations (HMOs) for providing primary care for long-stay nursing home (NH) residents and to compare this care with that of fee-for-service (FFS) residents at the same NHs.
  
  
  METHODS
  Cross-sectional interviews and case-studies, including retrospective chart reviews for 1 year.
  
  
  METHODS
  The programs were based in 20 community-based nursing homes in three regions (East, West, Far West).
  
  
  METHODS
  Administrative and professional staff of HMOs in three regions and 20 NHs; 215 HMO and 187 FFS residents at these homes were studied.
  
  
  METHODS
  Emergency department (ED) and hospital utilization.
  
  
  RESULTS
  All HMO programs utilized nurse practitioner/physician's assistants (NP/PA), but the structural configuration of physicians' (MD) practices differed substantially. At nursing homes within each region, all three HMO programs provided more total (MD plus NP/PA) visits per month than did FFS care (2.0 vs 1.1, 1.3 vs .6, and 1.4 vs .8 visits per month; all P < .05). The HMO that provided the most total visits had a significantly lower percentage of residents transferred to EDs (6% vs 16%, P = .048), fewer ED visits per resident (0.1 vs .4 per year, P = .027), and fewer hospitalizations per resident (0.1 vs .5 per year, P = .038) than FFS residents; these differences remained significant in multivariate analyses. However, the other two programs did not achieve the same benefits on healthcare utilization.
  
  
  CONCLUSIONS
  HMO programs for NH residents provide more primary care and have the potential to reduce ED and hospital use compared with FFS care. However, not all programs have been associated with decreased ED and hospital utilization, perhaps because of differences in structure or implementation problems.
authors.affiliation: UCLA Multicampus Program in Geriatric Medicine and Gerontology, Los Angeles, California 90095-1687, USA.
authors.forename: D B
authors.initials: DB
authors.lastname: Reuben
authors.forename: J F
authors.initials: JF
authors.lastname: Schnelle
authors.forename: J L
authors.initials: JL
authors.lastname: Buchanan
authors.forename: R S
authors.initials: RS
authors.lastname: Kington
authors.forename: G L
authors.initials: GL
authors.lastname: Zellman
authors.forename: D O
authors.initials: DO
authors.lastname: Farley
authors.forename: S H
authors.initials: SH
authors.lastname: Hirsch
authors.forename: J G
authors.initials: JG
authors.lastname: Ouslander
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006707:Homes for the Aged / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States; D014600:Utilization Review