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

r 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.


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

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