title: Fewer hospitalizations result when primary care is highly integrated into a continuing care retirement community.
abstract: Meeting the medical and social needs of elderly people is likely to be costly, disruptive, and at odds with personal preferences if efforts to do so are not well coordinated. We compared two different models of primary care in four different continuing care retirement communities. In the first model, used in one community, the physicians and two part-time nurse practitioners delivered clinical care only at that site, covered all settings within it, and provided all after-hours coverage. In the second model, used in three communities, on-site primary care physician hours were limited; the same physicians also had independent practices outside the retirement community; and after-hours calls were covered by all members of the practices, including physicians who did not practice on site. We found that residents in the first model had two to three times fewer hospitalizations and emergency department visits. Only 5 percent of those who died did so in a hospital, compared to 15 percent at the other sites and 27 percent nationally. These findings provide insight into what is possible when medical care is highly integrated into a residential retirement setting.
authors.affiliation: Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, New Hampshire, USA. julie.bynum@dartmouth.edu
authors.forename: Julie P W
authors.initials: JP
authors.lastname: Bynum
authors.forename: Alice
authors.initials: A
authors.lastname: Andrews
authors.forename: Sandra
authors.initials: S
authors.lastname: Sharp
authors.forename: Dennis
authors.initials: D
authors.lastname: McCollough
authors.forename: John E
authors.initials: JE
authors.lastname: Wennberg
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003363:Cost Control / Q000706:statistics & numerical data; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration* / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000458:organization & administration; D006760:Hospitalization / Q000706:statistics & numerical data*; D016852:Housing for the Elderly / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006801:Humans; D006278:Medicare / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data