Navigation Links
Managed care reduces hospitalizations in nursing home residents with advanced dementia
Date:9/26/2013

BOSTON Nursing home residents with advanced dementia commonly experience burdensome, costly interventions that do not improve their quality of life or extend their survival. Now a new study suggests that providing intensive primary care services may result in less burdensome and less costly care for these terminally ill residents.

Led by researchers at the Harvard Medical School-affiliated Institute for Aging Research at Hebrew SeniorLife, New York University School of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, the study appears in the Sept. 23 online issue of JAMA Internal Medicine.

The researchers analyzed data from 291 nursing home residents with advanced dementia, comparing those who were covered by managed care insurance to those enrolled in traditional fee-for-service Medicare insurance.

Most of these residents are dually eligible for traditional Medicare, which pays for hospital care and physician services on a fee-for-service basis, and Medicaid, which pays nursing homes for daily room, board and nursing care. Since nursing homes do not receive higher reimbursement to manage acutely ill long-term-care residents on-site, they have an incentive to transfer these residents to the hospital, temporarily shifting the cost of care from Medicaid to Medicare. In contrast, managed care programs combine Medicare and Medicaid costs for dual-eligible nursing home residents.

"Under managed care, the fiscal incentive for hospitalizing acutely ill nursing home residents with end-stage dementia goes away," explained co-author Susan L. Mitchell, M.D., M.P.H., a senior scientist at the Institute for Aging Research whose grants in part supported the research."We'd like policymakers to understand that this is an example of how a change in the system can lead to less burdensome, more affordable care."

Patients with advanced dementia no longer recognize their families, depend on others for their basic needs, speak fewer than five words, and are bedbound and incontinent. Based on earlier work led by Dr, Mitchell, advanced dementia is now viewed as a terminal illness; this work also showed that the families of most of these patients feel the main goal of care is comfort, although patients often receive aggressive care that does not promote that goal.

The new research showed that managed-care residents, who had more primary-care visits, predominantly from nurse practitioners, were more likely to have a do-not-hospitalize (DNH) order in place (63.7 percent for manage-care residents vs. 50.9 percent for fee-for-service residents). These residents also had fewer hospital transfers for acute illness (3.8 percent vs. 15.7 percent) than those in traditional Medicare insurance. In addition, the research suggests that managed-care residents may have been more likely to enter hospice, and that family members may have been more satisfied with overall care at the nursing home.

"We found no appreciable difference in survival outcomes between the managed care and fee-for-service groups," said lead author Keith S. Goldfeld, Dr.P.H., M.S., M.P.A., an instructor in biostatistics at New York University School of Medicine. "Comfort and other treatment outcomes also did not differ significantly."

Nursing home reimbursement policies are among the factors that lead to more aggressive care, noted Goldfeld. "If the payment structure is set up in a way that doesn't benefit the provider to hospitalize residents when they get sick by temporarily shifting costs, the research suggests that you may have equal or even improved outcomes."

The investigators also said this research should prompt families to consider opting for managed care or nurse practitioner-based insurance programs for their loved ones with advanced dementia who are in nursing homes.


'/>"/>

Contact: Jennifer Davis
jdavis@hsl.harvard.edu
617-363-8282
Hebrew SeniorLife Institute for Aging Research
Source:Eurekalert

Related medicine news :

1. Study examines federal government payments to separate managed care programs for same patients
2. Research and Markets Announces the Addition of a New Report, "Risk Sharing and Other Forms of Managed Entry Agreements for Medicines, Worldwide" to Their Offering
3. Critigen Managed Services Announces Implementation of ServiceNow for IT Service Automation
4. Verdasys Introduces New Managed Service for Cyber Threat Defense
5. Verdasys to Present New Managed Service for Cyber Threat Defense at Forrester's Forum for Security & Risk Professionals in London
6. Verdasys to Showcase Managed Service for Cyber Threat Defense at Gartner Security & Risk Summit
7. LDM Global Launches Managed Service, Provides Clients Increased Control, Reduced Cost, Low Risk
8. Managed Services Market to Reach $256.05 Billion by 2018 at a 12.4% CAGR - New Report by MarketsandMarkets
9. THE SIGNATURE GROUP Achieves Cisco Cloud and Managed Services Master Channel Partner Worldwide - Second Year Running
10. Managed Services Market by (Network, Mobility, Communications and Security) to Reach $256.05 Billion by 2018 – New Report by Marketsandmarkets
11. Trubiquity to Launch TRUcentrix™ 6.1 Featuring Managed File Transfer (MFT) and APQP Tracking Application at 2013 Quality Expo
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/26/2016)... ... June 26, 2016 , ... On June 10-11, 2016, A ... 2016 Cereal Festival and World’s Longest Breakfast Table in Battle Creek, MI, where the ... history as home to some of the world’s leading providers of cereal and other ...
(Date:6/26/2016)... ... 2016 , ... PawPaws brand pet supplements owned by Whole Health ... the health of felines. The formula is all-natural and is made from Chinese herbs ... Cat Kidney Support Supplement Soft Chews are Astragalus Root Extract and Rehmannia ...
(Date:6/26/2016)... Lake Orion, Clarkston, Michigan (PRWEB) , ... June ... ... direction with respect to fertility once they have been diagnosed with endometriosis. These ... tolerable intercourse but they also require a comprehensive approach that can help for ...
(Date:6/25/2016)... ... June 25, 2016 , ... Austin residents seeking Mohs surgery ... of Mohs Surgery and to Dr. Russell Peckham for medical and surgical dermatology. , ... for skin cancer. The selective fellowship in Mohs Micrographic Surgery completed by Dr. Dorsey ...
(Date:6/25/2016)... ... , ... "With 30 hand-drawn hand gesture animations, FCPX users can easily customize ... Pixel Film Studios. , ProHand Cartoon’s package transforms over 1,300 hand-drawn pictures into ... Simply select a ProHand generator and drag it above media or text in the ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... -- MedSource announced today that it has selected Datatrial,s ... choice.  This latest decision demonstrates MedSource,s commitment to ... by offering a state-of-the-art electronic data capture (EDC) ... the EDC platform of choice in exchange for ... long been a preferred EDC platform by our ...
(Date:6/23/2016)... -- Research and Markets has announced the ... (Organic Chemical (Sugar, Petrochemical, Glycerin), Inorganic Chemical), Functionality (Filler, ... Global Forecast to 2021" report to their offering. ... pharmaceutical excipients market is projected to reach USD 8.1 ... the forecast period 2016 to 2021. ...
(Date:6/23/2016)... June 23, 2016 Research and Markets ... Medical Market Analysis 2016 - Forecast to 2022" report ... The report contains up to date financial data derived from ... of major trends with potential impact on the market during ... market segmentation which comprises of sub markets, regional and country ...
Breaking Medicine Technology: