19 research outputs found
Better together: a community- hospital integrative model of healthcare as a practical solution for providing excellence in endocrinology care in an era of limited resources
Continuity of care and health care cost among communityâdwelling older adult veterans living with dementia
ObjectivesTo estimate the causal impact of continuity of care (COC) on total, institutional, and noninstitutional cost among communityâdwelling older veterans with dementia.Data SourcesCombined Veterans Health Administration (VHA) and Medicare data in Fiscal Years (FYs) 2014â2015.Study DesignFY 2014 COC was measured by the BiceâBoxerman Continuity of Care (BBC) index on a 0â1 scale. FY 2015 total combined VHA and Medicare cost, institutional cost of acute inpatient, emergency department [ED], longâ/shortâstay nursing home, and noninstitutional longâterm care (LTC) cost for medical (like skilledâ) and social (like unskilledâ) services were assessed controlling for covariates. An instrumental variable for COC (change of residence by more than 10 miles) was used to account for unobserved health confounders.Data CollectionCommunityâdwelling veterans with dementia aged 66 and older, enrolled in Traditional Medicare (NÂ =Â 102Â 073).Principal FindingsMean BBC in FY 2014 was 0.32; mean total cost in FY 2015 was 4045 lower total cost; (b) 119 lower ED cost, 402 higher noninstitutional medical LTC and $764 higher noninstitutional social LTC cost. BBC had no impact on shortâstay nursing home cost.ConclusionsCOC is an effective approach to reducing total health care cost by supporting noninstitutional care and reducing institutional care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167831/1/hesr13541.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167831/2/hesr13541-sup-0001-Authormatrix.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167831/3/hesr13541_am.pd
Continuity of Medical Care and Risk of Incarceration in HIV-Positive and High-Risk HIV-Negative Women
Continuity of care and quality care outcomes for people experiencing chronic conditions: A literature review
Preventive Care Utilization Among Children With and Without Special Health Care Needs: Associations With Unmet Need
Continuity of care and general wellbeing of patients with comorbidities requiring joint replacement
Aim. The aim of this paper is to examine the continuity of care and general wellbeing of patients with comorbidities undergoing elective total hip or knee joint replacement.Background. Advances in medical science and improved lifestyles have reduced mortality rates in most Western countries. As a result, there is an ageing population with a concomitant growth in the number of people who are living with multiple chronic illnesses, commonly referred to as comorbidities. These patients often require acute care services, creating a blend of acute and chronic illness needs. For example, joint replacement surgery is frequently performed to improve impaired mobility associated with osteoarthritis.Method. A purposive sample of twenty participants with multiple comorbidities who required joint replacement surgery was recruited to obtain survey, interview and medical record audit data. Data were collected during 2004 and 2005.Findings. Comorbidity care was poorly co-ordinated prior to having surgery, during the acute care stay and following surgery and primarily entailed prescribed medicines. The main focus in acute care was patient throughput following joint replacement surgery according to a prescribed clinical pathway. General wellbeing was less than optimal: participants reported pain, fatigue, insomnia and alterations in urinary elimination as the chief sources of discomfort during the course of the study.Conclusion. Continuity of care of comorbidities was lacking. Comorbidities affected patient general wellbeing and delayed recovery from surgery. Acute care, clinical pathways and the specialisation of medicine and nursing subordinated the general problem of patients with comorbidities. Systems designed to integrate and co-ordinate chronic illness care had limited application in the acute care setting. A multidisciplinary, holistic approach is required. Recommendations for further research conclude this paper.<br /