Evolution of Programs to Improve Transfers between Hospitals and Nursing Homes at the Community Level

Ronald Lagoe,Louise Pernisi,Barbara Drapola,Dorothy Haag

doi:10.4236/ojn.2015.57062

Abstract

This study described the evolution of programs to improve the efficiency of patient movement between hospitals and nursing homes in the metropolitan area of Syracuse, New York. These programs were needed in order to improve coordination among providers in the absence of networks that included both acute and long term care providers. The mechanisms included the exchange of data and monitoring the movement of Difficult to Place patients from hospitals to nursing homes. Between 2006 and 2014, the annual number of Difficult to Place patients increased from 983 to 1836. During this period, annual hospital medical/surgical discharges increased by 7.5 percent, severity of illness increased by 13.7 percent, and the population aged 65 years and over increased by 9.8 percent. Most of the Difficult to Place patients were admitted by the four largest facilities in the community, which accounted for 60 percent of the nursing home beds. The initiatives also included Subacute and Complex Care Programs that provided financial incentives for admission of certain types of patients, such as intravenous therapy and extensive wound care. The programs described how these programs were implemented using minimal financial resources and without adding positions to the participating provider organizations.

Highlights

In the United States, the need for provider efficiency in the delivery of health care is increasing
The initial component of the study focused on changes in numbers of Difficult to Place patients admitted to nursing homes from the Syracuse hospitals with changes in other utilization and demographic indicators
These data demonstrated that the total number of Difficult to Place patients in the Syracuse hospitals increased by 86.6 percent, from 983 to 1836, between 2006 and 2014

Summary

Introduction

In the United States, the need for provider efficiency in the delivery of health care is increasing. The rate of increase in health care expenses has slowed in recent years, the pressure on providers for efficiency in the delivery of care continues to rise [1] [2] This need may be most apparent for acute hospitals, historically one of the most expensive sectors of health care. The aging of populations, as well as rising costs of labor, pharmaceuticals, and technology, have continued to push hospitals to limit utilization and related expenses [3] [4] These developments have stimulated increasing levels of coordination between hospitals and long term care providers because of the need to discharge acute care patients to appropriate levels of care [5] [6]. These programs did not have a major impact on hospital patients with long stays in nursing homes [7] [8]

Methods

Results

Conclusion