Biomaterial Database

Managed primary care of nursing home residents. 1998

A Joseph, and C Boult

Department of Continuing Care Services, Southern California Medical Group, San Diego 92120, USA.

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.

UI	MeSH Term	Description	Entries
D008297	Male		Males
D009026	Mortality	All deaths reported in a given population.	CFR Case Fatality Rate,Crude Death Rate,Crude Mortality Rate,Death Rate,Age Specific Death Rate,Age-Specific Death Rate,Case Fatality Rate,Decline, Mortality,Determinants, Mortality,Differential Mortality,Excess Mortality,Mortality Decline,Mortality Determinants,Mortality Rate,Mortality, Differential,Mortality, Excess,Age-Specific Death Rates,Case Fatality Rates,Crude Death Rates,Crude Mortality Rates,Death Rate, Age-Specific,Death Rate, Crude,Death Rates,Determinant, Mortality,Differential Mortalities,Excess Mortalities,Mortalities,Mortality Declines,Mortality Determinant,Mortality Rate, Crude,Mortality Rates,Rate, Age-Specific Death,Rate, Case Fatality,Rate, Crude Death,Rate, Crude Mortality,Rate, Death,Rate, Mortality,Rates, Case Fatality
D009735	Nursing Homes	Facilities which provide nursing supervision and limited medical care to persons who do not require hospitalization.	Homes, Nursing,Nursing Home
D010348	Patient Care Team	Care of patients by a multidisciplinary team usually organized under the leadership of a physician; each member of the team has specific responsibilities and the whole team contributes to the care of the patient.	Health Care Team,Interdisciplinary Health Team,Medical Care Team,Multidisciplinary Care Team,Multidisciplinary Health Team,Healthcare Team,Care Team, Health,Care Team, Medical,Care Team, Multidisciplinary,Care Team, Patient,Care Teams, Health,Care Teams, Patient,Health Care Teams,Health Team, Interdisciplinary,Health Team, Multidisciplinary,Healthcare Teams,Interdisciplinary Health Teams,Medical Care Teams,Multidisciplinary Care Teams,Multidisciplinary Health Teams,Patient Care Teams,Team, Health Care,Team, Healthcare,Team, Interdisciplinary Health,Team, Medical Care,Team, Multidisciplinary Care,Team, Multidisciplinary Health,Team, Patient Care,Teams, Interdisciplinary Health
D011320	Primary Health Care	Care which provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. (JAMA 1995;273(3):192)	Primary Care,Primary Healthcare,Care, Primary,Care, Primary Health,Health Care, Primary,Healthcare, Primary
D002140	California	State bounded on the east by Nevada and Arizona, on the south by Mexico and the Pacific Ocean on the south and west, and on the north by Oregon.
D003695	Delivery of Health Care	The concept concerned with all aspects of providing and distributing health services to a patient population.	Delivery of Dental Care,Health Care,Health Care Delivery,Health Care Systems,Community-Based Distribution,Contraceptive Distribution,Delivery of Healthcare,Dental Care Delivery,Distribution, Non-Clinical,Distribution, Nonclinical,Distributional Activities,Healthcare,Healthcare Delivery,Healthcare Systems,Non-Clinical Distribution,Nonclinical Distribution,Activities, Distributional,Activity, Distributional,Care, Health,Community Based Distribution,Community-Based Distributions,Contraceptive Distributions,Deliveries, Healthcare,Delivery, Dental Care,Delivery, Health Care,Delivery, Healthcare,Distribution, Community-Based,Distribution, Contraceptive,Distribution, Non Clinical,Distributional Activity,Distributions, Community-Based,Distributions, Contraceptive,Distributions, Non-Clinical,Distributions, Nonclinical,Health Care System,Healthcare Deliveries,Healthcare System,Non Clinical Distribution,Non-Clinical Distributions,Nonclinical Distributions,System, Health Care,System, Healthcare,Systems, Health Care,Systems, Healthcare
D005260	Female		Females
D006279	Health Maintenance Organizations	Organized systems for providing comprehensive prepaid health care that have five basic attributes: (1) provide care in a defined geographic area; (2) provide or ensure delivery of an agreed-upon set of basic and supplemental health maintenance and treatment services; (3) provide care to a voluntarily enrolled group of persons; (4) require their enrollees to use the services of designated providers; and (5) receive reimbursement through a predetermined, fixed, periodic prepayment made by the enrollee without regard to the degree of services provided. (From Facts on File Dictionary of Health Care Management, 1988)	Group Health Organizations, Prepaid,HMO,Prepaid Group Health Organizations,Health Maintenance Organization,Organizations, Health Maintenance,Organization, Health Maintenance
D006296	Health Services	Services for the diagnosis and treatment of disease and the maintenance of health.	Services, Health,Health Service