Navigation Links
Study compares types of insurance of nursing home residents and likelihood of being hospitalized

Elderly nursing home residents with advanced dementia who were enrolled in a Medicare managed care insurance plan were more likely to have do-not-hospitalize orders and were less likely to be hospitalized for acute illness than those residents enrolled in traditional Medicare, according to a study published by JAMA Internal Medicine, a JAMA Network publication.

Recent health care reform in the United States increases opportunities to improve the quality and cost-effectiveness of care provided to nursing home residents with advanced dementia. Because nursing homes do not receive higher reimbursement to manage acutely ill long-term-care residents on site, nursing homes have had financial incentives to transfer residents to hospitals, according to the study background.

Keith S. Goldfeld, Dr.P.H., M.S., M.P.A., of the NYU School of Medicine, New York, and colleagues compared care and outcomes for nursing home residents with advanced dementia covered by managed care and those covered by traditional fee-for-service Medicare. The analysis included 291 residents from 22 nursing homes in the Boston area.

Residents enrolled in managed care (n=133) were more likely to have do-not-hospitalize orders compared with those in traditional Medicare (n=158) (63.7 percent vs. 50.9 percent); were less likely to be transferred to the hospital for acute illness (3.8 percent vs. 15.7 percent); had more nursing home-based primary care visits per 90 days (average 4.8 vs. 4.2); and had more nursing home-based nurse practitioner visits (3.0 vs. 0.8), according to the study results. Survival did not differ between groups.

"This study provides novel data suggesting that the model of health care delivery in a nursing home has important effects on the type of care received by individual residents. Intensive primary care services may be a promising approach to ensure that nursing homes are able to provide appropriate, less burdensome and affordable care, especially at the end of life. Ultimately, it may require a change in the underlying financial structure to institute those changes," the study concludes.

(JAMA Intern Med. Published online September 23, 2013. doi:10.1001/jamainternmed.2013.10573. Available pre-embargo to the media at

Editor's Note: This study was supported in part by grants from the National Institute on Aging. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Commentary: The Right Care in the Right Place

In an invited commentary, William J. Hall, M.D., M.A.C.P., writes: "Two key factors stand out from this study. First, more onsite nurse practitioners in nursing homes resulted in better outcomes irrespective of insurance status. Second, present Medicaid reimbursement creates perverse incentives against the delivery of appropriate comfort and palliative care such as hospital services."

"Design of a long-term system that will provide our patients with advanced dementia the right care at the right time will require more than patches and fixes to the payments systems," Hall continues.

"Finally, no individual is admitted to a hospital or nursing home without the authorization of a physician. We, more than any other members of the health care team, have the authority and responsibility to advocate for the appropriate level of care for our patients during the terminal phase of advanced dementia," Hall concludes.

(JAMA Intern Med. Published online September 23, 2013. doi:10.1001/jamainternmed.2013.8592. Available pre-embargo to the media at

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.


Contact: Lorinda Klein
The JAMA Network Journals

Related medicine news :

1. CDC, Mass. General study reveals that preventing malaria in travelers to West Africa reduces health costs
2. New JAMA Study Highlights Mobility Limitation as Key to Healthy Aging
3. New study identifies preferred method to assess patient reactions to radiation therapy
4. SU physicist develops model for studying tissue pattern formation during embryonic development
5. Study finds link between commonly prescribed statin and memory impairment
6. Professors at Purchase College and Columbia University Receive More Than $500,000 in Grants to Study New Ways to Reduce Anxiety Disorders
7. Penn Medicine study: Proton therapy cuts side effects for pediatric head and neck cancer patients
8. Study: Majority of patients who qualify for lifesaving heart treatment do not receive it
9. Mayo-led study: Drug fails to reduce diarrhea in patients receiving radiation therapy
10. Loyola study assesses use of fingerstick blood sample with i-STAT point-of-care device
11. Brain may rely on computer-like mechanism to make sense of novel situations, says CU-Boulder study
Post Your Comments:
(Date:11/30/2015)... (PRWEB) , ... November 30, 2015 , ... ... lecturer at a University of Delaware Accounting and Management of Information Systems course. ... solutions for mid-market businesses. Sommer will speak at before student in the Enterprise ...
(Date:11/30/2015)... Doylestown, PA (PRWEB) , ... November 30, 2015 , ... ... the 15th annual Regional Biotech Conference, organized by the Baruch S. Blumberg Institute. , ... than 100 of the area’s life science and biotechnology leaders for the conference, which ...
(Date:11/30/2015)... ... November 30, 2015 , ... ... teams looking to maximize recovery through quality sleep. Tim DiFrancesco, training coach for ... a better night’s sleep. ChiliPad precisely regulates the surface temperature of each side ...
(Date:11/30/2015)... NJ (PRWEB) , ... November 30, 2015 , ... Dr. ... With three office locations, patients can visit Dr. Margulies to experience the best available ... to hold the title of "NJ Top Dentist"! , Orthodontics is the branch of ...
(Date:11/30/2015)... ... November 30, 2015 , ... The recently published 32nd ... System (NPDS) reveals that in 2014, someone called a poison center about every ... of which were human exposure cases. , The American Association of Poison Control ...
Breaking Medicine News(10 mins):
(Date:11/30/2015)... REDWOOD CITY, Calif. , Nov. 30, 2015 ... company that is providing innovative evidence-based solutions for the treatment ... Appeals Board (PTAB) at the U.S. Patent and Trademark Office ... (IPR) of U.S. Patent No. 8,359,102 (the ,102 patent).  ... 14, 2015, a unit of Boston Scientific Corporation filed two ...
(Date:11/30/2015)... AMSTERDAM , Nov. 30, 2015   ... today announced the launch of Radiology Solutions, a ... management. Radiology Solutions comprises customized, data-driven practice management ... analytics to help radiology practices improve care delivery ... 2015 Radiological Society of North America Annual ...
(Date:11/30/2015)... AMSTERDAM , Nov. 30, 2015   Royal ... introduced ScanWise Implant, the industry,s first MRI guided user ... the scanning of patients with MR Conditional implants, such ... at the 2015 Radiological Society of North America ... streamline exams and supports diagnostic confidence of this growing ...
Breaking Medicine Technology: