Extended Care in Nursing Homes: A Program for a County Teaching Medical Center

Abstract

A continuity care program for patients in nursing homes using internal medicine residents in training has been developed in a county teaching hospital. Resident physicians on a paid basis assume primary care responsibility for 1000 patients in 29 private community nursing homes. A faculty internist coordinates the activities of the residents and monitors patient care through an extended care office in the county hospital. The program has produced a significant upgrading of the continuity and quality of care of patients in these nursing homes as well as providing medical residents with geriatric and nursing home experience. The increased sensitivity and concern for the needs of nursing home patients developed by the medical residents seems to continue after they complete their training.

A Randomized Study of Ciprofloxacin versus Ceftriaxone in the Treatment of Nursing Home‐Acquired Lower Respiratory Tract Infections

“…The lower mortality rates observed in the present study (8%) and our previous study (6.5%), 14 compared to other reports, 3–5 may be attributed to early recognition of the frequently atypical presentation of bronchopulmonary infection in the elderly nursing home patient. Identifying infection early in its course was made possible by the structure of our Extended Care Program 14 , 15 …”

“…From January 1988 to March 1990, 50 elderly (defined as age 60 years or older) nursing home residents in the Extended Care Program 14 , 15 at Hennepin County Medical Center, who were admitted to the hospital for treatment of lower respiratory tract infections, were enrolled in the study. The criteria for the diagnosis of pneumonia were (1) at least one of the following: cough, oral temperature greater than 37.2°C, dyspnea, peripheral white blood cell count greater than 10,000/mm, 3 and (2) the presence of new infiltrates on chest roentgenogram interpreted as compatible with the diagnosis.…”

Do‐Not‐Resuscitate Orders in an Extended‐Care Study Group

“…Setting The extended‐care program at Hennepin County Medical Center (HCMC), a 434‐bed teaching hospital affiliated with the University of Minnesota, has been previously described 10 . It provides care for approximately 911 residents of 45 nursing homes throughout Hennepin County.…”

Resident Training in Nursing Home Care: Survey of Successful Educational Strategies

“…Respondents from both specialties, however, recommended employing such an individual to help coordinate patient assignments, review patient progress, handle intercurrent patient care problems, provide continuity, and assist in resident evaluation. A large proportion of the residency nursing home programs reported in the literature describe successfully employing nurse practitioners in similar capacities 29,31,33,34 . Non‐physician practitioners, therefore, can make significant contributions to resident education in the nursing home, and their involvement may allow programs with fewer physician faculty resources to establish or improve their nursing home rotation.…”

“…[18][19][20]22 Indeed, our survey results indicate that most geriatric medicine content areas recommended by AGS receive some emphasis in nursing home curricula, with many areas given substantial to major emphasis." Despite the nursing home being described as an ideal setting to teach principles of rehabilitation.P: 20-22, 28, 31, 32 coordination of care between settings (ie, nursing home, hospital, and outpatientj.P: 26,[32][33][34]37 and organization and financing of health care,2t, 26,28,31,35,36 these content areas received relatively little attention in current programs. Deliberate structuring of geriatric curriculum objectives by site (ie, acute, nursing home, ambulatory, and home care) and universal use of specific educational objectives may prevent these shortcomings and better ensure that program goals are achieved.…”