hospitalizations. This approach was evaluated in a randomized experimental design study measuring its impact on health care utilization, functional changes in patients, and patient and caretaker
Inconsistent results in studies of cost-effectiveness of home health care have led to the need for identification of target populations for whom cost-savings can be anticipated if expanded home care programs are introduced. This analysis of results of a randomized controlled study of efficacy of a physician/geriatric nurse practitioner/social worker home care team identifies such a potential target population. The team provides round-the-clock on-call medical services in the home when needed, in addition to usual nursing and other home care services, to home-bound chronically or terminally ill elderly patients. Overall health services utilization and estimated costs were not substantially different for the patients who did not die while in the study; however, for those who did die, team patients had considerably lower rates of hospitalization and overall cost than controls, and more frequently died at home. Of 21 team and 12 control patients who died but had at least two weeks of utilization experience in the study, team patients had about half the number of hospital days compared with controls during the terminal two weeks, and although they had more home care services, had only 69 per cent of the estimated total health care costs of the controls. Satisfaction with care received was significantly greater among the total group of team patients, and especially among their family caretakers, than among controls. This model is effective in providing appropriate medical care for seriously ill and terminal patients, and in enabling them to die at home if they so wish, while at the same time reducing costs of care during the terminal period.
Group A Streptococcus has been identified as the cause of several outbreaks of infection in residents of nursing homes. These reports described outbreaks that included persons with severe invasive disease as well as more limited infection. The purpose of this report is to describe an investigation of two consecutive outbreaks of group A Streptococcus that occurred in a single nursing home, where all affected residents had disease of mild to moderate disease severity. This report focuses on the identification of risk factors for infection and describes the approach used to control the spread of infection in the nursing home.
A self-administered time-motion study of the activities of a home care team, consisting of physician, nurse practitioner and social worker is reported. The patients were home-bound, chronically or terminally ill and largely elderly, and the physician and nurse practitioner were available by telephone and for emergency visits on a 24-hour, 7 day per week basis. A systematic sample of 24 hour calendar days was studied; the average team patient census was 54 (the team had other clinical responsibilities in addition). Time spent on travel, home visits and on team conferencing and consultation was higher than in other practices, as might be expected. Full-time equivalent requirements for this type of care program were extrapolated to come to approximately one physician and social worker and one and one-half nurse practitioner per 100 patients. A truer estimate of actual costs of provision of team services to home-bound patients can be provided by this method than by the usual calculation of charges based only on actual home visits.
Group A Streptococcus has been identified as the cause of several outbreaks of infection in residents of nursing homes. These reports described outbreaks that included persons with severe invasive disease as well as more limited infection. The purpose of this report is to describe an investigation of two consecutive outbreaks of group A Streptococcus that occurred in a single nursing home, where all affected residents had disease of mild to moderate disease severity. This report focuses on the identification of risk factors for infection and describes the approach used to control the spread of infection in the nursing home.
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