The Effect of Evercare on Hospital Use

Kane, Robert L; Keckhafer, Gail; Flood, Shannon; Bershadsky, Boris; Siadaty, Mir S.

doi:10.1046/j.1532-5415.2003.51461.x

Cited by 272 publications

(252 citation statements)

References 14 publications

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“…11 A corroborative inquiry found that subsequent hospitalization rates were cut almost in half when nurse practitioners directly managed the primary care of nursing home residents. 12 A recent 3-year study of worksite health clinics suggested that every dollar spent on nurse practitioners saved several dollars that otherwise would have been spent for physician treatment of major diagnostic conditions. 13 A study in Tennessee found that costs at nurse practitioner-managed practices were 23% below the costs of care delivered by other primary care providers; inpatient hospitalization rates were 21% lower.…”

Section: The Cost Side Of the Equation: Advantage Of Nurse Practitionersmentioning

confidence: 99%

Nurse practitioners as an underutilized resource for health reform: Evidence‐based demonstrations of cost‐effectiveness

Bauer¹

2010

Journal of the American Academy of Nurse Practitioners

119

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is an internationally recognized medical economist and health futurist. He has published over 180 articles and books on the health industry, including numerous economic analyses of input substitution as a key to reducing costs and improving quality in medical care delivery. With a career that includes 17 years as a professor of statistics and research at two medical schools and service as health policy adviser to a state governor, he is now a Chicago-based partner in management consulting and leader of the futures practice for Affiliated Computer Services (ACS, Inc.). AbstractHealthcare reform in 2009 was motivated by an imperative to reduce the relentless increase in spending on medical care. Many efforts to solve the problem focused on applying proven principles of evidence-based practice and cost-effectiveness to find the least-expensive way to produce a specific clinical service of acceptable quality. This paper combines economic analysis and reviews published literature to show how the goals of healthcare reform can be accomplished by allowing independently licensed nurse practitioners to provide their wide range of services directly to patients in a variety of clinical settings. The paper presents extensive, consistent evidence that nurse practitioners provide care of equal or better quality at lower cost than comparable services provided by other qualified health professionals.

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Section: The Cost Side Of the Equation: Advantage Of Nurse Practitionersmentioning

confidence: 99%

Nurse practitioners as an underutilized resource for health reform: Evidence‐based demonstrations of cost‐effectiveness

Bauer¹

2010

Journal of the American Academy of Nurse Practitioners

119

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“…Involvement of NPs and PAs in collaboration with primary care physicians has repeatedly been shown to be associated with less hospitalization of NH residents. [12][13][14][23][24][25] Involving these health professionals in care transition interventions in which acute hospitals collaborate with NHs and home health agencies would build upon evolving models, 26,27 but the number of healthcare professionals with special training and interest in geriatrics and long-term care medicine is not increasing rapidly enough to meet this need. 28 Financial incentives to obtain certification in geriatrics or work in NHs, such as loan repayment programs, and the development of a specialty in NH medicine 29 may help in this regard.…”

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confidence: 99%

“…The unreimbursed costs, as well as the potential regulatory and legal liabilities of caring for sicker residents, are potent disincentives to managing residents with acute changes in status in the NH. [19][20][21][22] Managed care programs such as Evercare and others mitigate these financial incentives and have been shown to reduce hospitalization of NH residents when teams of physicians and NPs or PAs provide more care in the NH, 14,23,24 but the number of NH residents in these programs remains small.…”

mentioning

confidence: 99%

Potentially Avoidable Hospitalizations of Nursing Home Residents: Frequency, Causes, and Costs

Ouslander

Lamb

Perloe

et al. 2010

J American Geriatrics Society

419

387

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OBJECTIVES:To examine the frequency and reasons for potentially avoidable hospitalizations of nursing home (NH) residents. DESIGN: Medical records were reviewed as a component of a project designed to develop and pilot test clinical practice tools for reducing potentially avoidable hospitalization. SETTING: NHs in Georgia. PARTICIPANTS: In 10 NHs with high and 10 with low hospitalization rates, 10 hospitalizations were randomly selected, including long-and short-stay residents. MEASUREMENTS: Ratings using a structured review by expert NH clinicians. RESULTS: Of the 200 hospitalizations, 134 (67.0%) were rated as potentially avoidable. Panel members cited lack of on-site availability of primary care clinicians, inability to obtain timely laboratory tests and intravenous fluids, problems with quality of care in assessing acute changes, and uncertain benefits of hospitalization as causes of these potentially avoidable hospitalizations. CONCLUSION: In this sample of NH residents, experienced long-term care clinicians commonly rated hospitalizations as potentially avoidable. Support for NH infrastructure, clinical practice and communication tools for health professionals, increased attention to reducing the frequency of medically futile care, and financial and other incentives for NHs and their affiliated hospitals are needed to improve care, reduce avoidable hospitalizations, and avoid unnecessary healthcare expenditures in this population. J Am Geriatr Soc 58:627-635, 2010.Key words: nursing homes; avoidable hospitalizations; transfers; quality H ospitalization of nursing home (NH) residents can cause discomfort for residents, anxiety for their loved ones, morbidity due to iatrogenic events, and excess healthcare costs. Many of these hospitalizations may be preventable through better care in the NH or inappropriate, because the transfer exposes NH residents to additional risks associated with hospitalization, 1 without substantial potential benefit for the residents' clinical course or quality of life. Previous in-depth research on the overall frequency and costs of potentially avoidable hospitalizations of nursing home residents is limited. One study found that, in 2004, 23% of the $972 million spent on hospitalizations of long-stay NH residents in the state of New York were for ambulatory care-sensitive diagnoses (ACSDs), a proxy measure for potentially unnecessary hospitalizations. 2ACSDs include diagnoses such as angina pectoris, heart failure, chronic obstructive pulmonary disease, pneumonia, urinary tract infection, cellulitis, diabetes mellitus, and dehydration. 3 This is an underestimate of the overall costs of these hospitalizations, because short-stay residents, in whom hospitalizations are more common than long-stay residents, were excluded from this analysis. A study of hospital admissions from Canadian long-term care facilities found 55% to be due to a modified list of ACSD. 4 In an analysis of hospital transfers from eight Los Angeles NHs, experienced physicians using a structured implicit record re...

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“…One potential explanation for this is that in addition to the staff investment, the reduction in potentially avoidable hospitalization may need nursing homes to invest in the clinical resources (e.g. diagnostic services, nurse practitioners/physician assistants, intravenous therapy) so as to manage the residents' acute care needs on-site [29, [183][184][185][186], or make specific changes in practice such as improvement in preventive services, chronic disease management, to prevent the need for hospitalization. Furthermore, nursing homes have no clear incentives to reduce the likelihood of hospitalization as hospital services are paid by Medicare.…”

Section: Changes In Quality Of Nursing Home Carementioning

confidence: 99%

Medicaid Reimbursement and the Quality of Nursing Home Care: A Case Study of Medi-Cal Long-Term Care Reimbursement Act of 2004 in California

Xing¹,

Mukamel²,

Glance³

et al. 2016

WHM

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2013ii Biographical SketchThe author was born in Shanghai, China. She attended Shanghai Second Medical This dissertation provides evidence that linking Medicaid reimbursement rate to each NH's own expenditures and incentivizing NHs to invest in direct care were effective ways in achieving quality improvement. Refinements of current Medi-Cal reimbursement policy might be needed to encourage NHs to make larger investments. However, maximizing NHs' spending on direct care cannot be relied on as the only policy strategy to improve quality of care. vii Contributors and Funding SourcesThis work was supervised by a dissertation committee consisting of Professors

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The Effect of Evercare on Hospital Use

Abstract: The use of active primary care provided by NPs may have prevented the occurrence of some hospitalizable events, but its major effect was allowing cases to be managed more cost-effectively.

Cited by 272 publications

References 14 publications

Nurse practitioners as an underutilized resource for health reform: Evidence‐based demonstrations of cost‐effectiveness

Nurse practitioners as an underutilized resource for health reform: Evidence‐based demonstrations of cost‐effectiveness

Potentially Avoidable Hospitalizations of Nursing Home Residents: Frequency, Causes, and Costs

Medicaid Reimbursement and the Quality of Nursing Home Care: A Case Study of Medi-Cal Long-Term Care Reimbursement Act of 2004 in California

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