Physicians spend a considerable amount of time providing care outside of office visits for patients with chronic illness. This study suggests that collecting empirical data on the amount and nature of nonreimbursed care activities is feasible and should be done in more generalizable settings to inform debates about reimbursement reform.
BACKGROUND:The traditional acute care for the elderly (ACE) unit has demonstrated improved functional outcomes without increased costs or changes in length of stay (LOS). It is, however, limited in scope to patients cared for on a fixed geographical unit.OBJECTIVE:To compare operational and quality outcomes for patients cared for on a mobile ACE (MACE) service to those cared for on a unit‐based ACE service and matched controls on other general medical services.DESIGN:Retrospective cohort study with propensity‐score matching.SETTING:An urban academic medical center.PATIENTS:A total of 8094 hospitalized adults >64 years old admitted to an ACE, MACE, and general medical services from July 2006 to June 2009.INTERVENTION:An interdisciplinary MACE service com‐ posed of a geriatrician‐hospitalist, fellow, nurse coordinator, and social worker.MEASUREMENTS:LOS, total cost, 7‐ and 30‐day readmission rates, and in‐hospital mortality.RESULTS:Mean LOS and total cost were significantly lower for patients in the MACE service compared with the ACE unit service (5.8 vs 7.9 days, P < 0.001, and $10,315 vs $13,187, P = 0.002) and compared with propensity‐score matched controls during the second year of operation (5.6 vs 7.2 days, P < 0.001, and $10,693 vs $15,636, P < 0.001). In‐hospital mortality and 7‐ and 30‐day readmission rates were similar in all groups.CONCLUSIONS:A mobile ACE service may result in reduced LOS and lower costs with no change in in‐hospital mortality or 7‐ or 30‐day readmission rates when compared with standard medical service and a traditional unit‐based ACE service. Journal of Hospital Medicine 2011;6:358–363. © 2011 Society of Hospital Medicine
Background/Objectives Homebound elderly patients with chronic medical illnesses face multiple barriers to care. Primary care physicians (PCPs) devote a significant amount of time to care apart from actual office visits, but there is little quantification of such time by physicians who provide primary care in the home. This article assesses exactly how much time physicians in a large home based primary care (HBPC) program spend providing care outside of home visits. Unreimbursed time, as well as patient and provider-related factors that may contribute to that increased time, are considered. Design Mount Sinai Visiting Doctors (MSVD) providers filled out research forms for every interaction involving care provision outside of home visits. Data collected included: length of interaction, mode, nature, and whom the interaction was with for 3 weeks. Setting/Participants MSVD is an academic home-visit program in Manhattan, NY. All PCPs in MSVD (n=14) agreed to participate. Measurements Time data were analyzed using a comprehensive estimate and conservative estimates to quantify unbillable time. Results Data on 1151 interactions for 537 patients were collected. An average 8.2 hours/week were spent providing non-home visit care for a full-time provider. Using the most conservative estimates, 3.6 hours/week was estimated to be unreimbursed per full-time provider. No significant differences in interaction times were found among dementia vs. non-dementia patients, new vs. non-new patients, and primary-panel vs. covered patients. Conclusion Findings suggest that HBPC providers spend substantial time providing care outside home visits, much of which goes unrecognized in the current reimbursement system. These findings may help guide practice development and creation of new payment systems for HBPC and similar models of care.
ObjectivesRe-admissions after hospitalisation are a burden for patients and costly. Our objective was to examine whether re-admissions were increased among older patients when they or their surrogates disagreed with the discharge disposition recommended by the clinical team at hospital discharge.DesignRetrospective cohort study.SettingLarge academic medical centre in New York, NY.Participants514 hospital discharges of older patients admitted to a geriatric inpatient service between 1 July 2007 and 30 June 2008.Primary outcome measure and main independent variableRe-admissions for any reason to any hospital within 30 days after discharge were identified. Agreement or disagreement with the discharge disposition recommended by the clinical team at hospital discharge was assessed.ResultsAmong 514 hospital discharges of older patients, the mean age was 83.1 years (SD=8.3), 75.7% were women, and approximately 90% were living at home prior to hospitalisation, despite 47.1% having some degree of cognitive impairment and 56.4% requiring assistance for activities of daily living or independent activities of daily living. There were 42 (8.2%) disposition disagreements; the majority (n=25; 59.5%) were discharged home despite the clinical team's recommendation for discharge to an acute or subacute facility. Overall, 158 (30.7%) were re-admitted within 30 days. There was no difference in re-admission rates between discharges with and without disposition disagreements (33.3% (144 of 472) vs 30.5% (14 of 42), respectively; OR=1.14, 95% CI 0.57 to 2.19; p=0.71). Adjusted analyses were consistent with these findings.ConclusionsDischarge disposition disagreements occurred relatively infrequently after hospitalisation among a group of older patients managed by a geriatrics inpatient service. In addition, we found no differences in re-admission when comparing patients who agreed or disagreed with the clinical team's recommended discharge disposition.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.