Who Cares for Missouri's Medicaid Nursing Home Residents? Characteristics of Attending Physicians

Objective: To describe the characteristics of physicians attending Medicaid recipients in Missouri\u27s certified nursing homes (NH). Design: Retrospective survey of multiple data sources. Setting: Missouri\u27s certified nursing homes. Participants: 1,339 physicians attending 22,452 Medicaid recipients. Measurements: Physician characteristics were determined by reviewing a roster of medical directors of NHs compiled by the Missouri Department of Social Services\u27 Division of Aging and physician directories compiled by the Missouri State Board of Registration for the Healing Arts, the AMA, the AOA, the ABFP, and the ABIM. Physician clinical activity was determined by examining NH inspection of care reports compiled by the Missouri Department of Social Services\u27 Division of Aging. Results: Each physician attended a mean of 16.8 and a median of six Medicaid recipients in the nursing home. The skewed distribution is reflected by 426 (31.8%) of the physicians attending only one or two residents, and 28 (2.1%) of the physicians attending 100 or more residents. Twenty-seven percent of the state\u27s licensed osteopaths (DOs, 362) attended nursing home patients, compared with 11% of allopathic physicians (MDs, 977). Significantly more DOs than MDs attended more than the median number of patients (57% vs 45%, P \u3c 0.001). Half were attended by the 605 (45%) physicians without board certification. Of those who were board certified, family physicians were more likely to include Medicaid nursing home patients in their practices than internists (43% vs 18%, P \u3c 0.001). Physicians licensed for 11 to 20 years and rural physicians had the heaviest patient loads. Conclusions: Many doctors are caring for very few nursing home residents while a few doctors may be caring for too many patients. In addition, half the Medicaid recipients residing in Missouri\u27s nursing homes in 1988 were attended by physicians without board certification, and almost one-third were attended by physicians who may be retiring between 2000 and 2010

Predicting Discharge Outcomes of VA Nursing Home Residents

This article's purpose was to identify predictors of discharge outcomes of VA nursing home stays. Using data tapes, diagnostic and assessment data were assembled on elderly individuals admitted to VA nursing homes nationwide during Fiscal Year 1987. Six-month outcomes for 3 groups were considered: all residents (n = 5,895), and those remaining in care after 6 (n = 2,815) and 12 months (n = 1,812), respectively. Logistic regression was used to evaluate predictors of death and community discharge. Limited activities of daily living (ADL) dependency, younger age, and receipt of rehabilitation services most consistently predicted community discharge. ADL dependency, older age, oxygen use, terminally ill prognosis, malignancy, and congestive heart failure most consistently predicted mortality. For both dependent variables, predictive ability declined as stay length increased. Predicting death and community discharge become increasingly problematic as stay lengthens. Comparing observed versus expected discharge outcomes has limited usefulness as a quality-improvement tool.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67481/2/10.1177_089826439700900206.pd