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:11/27/2015)... ... November 27, 2015 , ... CBD College is proud ... Education Programs (CAAHEP) awarded accreditation to its Diagnostic Medical Sonography program. CBD College is ... only one of twelve colleges and universities in the state of California make the ...
(Date:11/27/2015)... , ... November 27, 2015 , ... ... center software Q-Suite, announces the incorporation of Asterisk 11 LTS (Long Term Support) ... supported Asterisk 11 LTS brings Q-Suite 5.10 up-to-date with a version of Asterisk ...
(Date:11/26/2015)... Ashburn, VA (PRWEB) , ... November 26, 2015 ... ... Planners, an American Express Travel Representative. As a franchise owner, Somu now offers ... range of cruise, destination wedding packages, private cruise sales, as well as, cabin ...
(Date:11/26/2015)... Mass. (PRWEB) , ... November 26, 2015 , ... ... thorough second medical opinion process, participated in the 61st annual Employee Benefits Conference. ... Plans and took place Sunday, November 8th through Wednesday, November 11th, 2015. The ...
(Date:11/25/2015)... ... 25, 2015 , ... Additional breast cancers found with MRI ... to a study published online in the journal Radiology. Researchers said that in ... a change in treatment. , Breast MRI is the most sensitive technique for ...
Breaking Medicine News(10 mins):
(Date:11/26/2015)... , November 26, 2015 /PRNewswire/ ... announced the addition of the  "2016 ... the European Therapeutic Drug Monitoring (TDM) ... Competitive Intelligence, Emerging Opportunities"  report to ... ) has announced the addition of ...
(Date:11/26/2015)... -- ) has announced the ... Viscosity Drugs" report to their offering. ... of the "Self Administration of High Viscosity ... Research and Markets ( ) has ... of High Viscosity Drugs" report to their ...
(Date:11/26/2015)... , November 26, 2015 ... addition of the "Radioimmunoassay Market by ... (Hospital, Pharmaceutical Industry, Academics, Clinical Diagnostic Labs), ... Global Forecast to 2020" report to ... has announced the addition of the ...
Breaking Medicine Technology: