Hospitalization in the Program of All‐inclusive Care for the Elderly (PACE): Rates, Concomitants, and Predictors

Abstract

Overall, short-term hospital utilization among PACE participants is low in contrast with that for other older and disabled populations. Participant predictors of hospitalization in PACE are generally consistent with other studies in older clinical and community populations. Both utilization and risk vary considerably across PACE sites, independent of participant-level risk factors, hence suggesting that further investigation is required to study PACE's management of acute illness and hospitalization decisions. Critical to maintaining PACE's success is an understanding of the independent impact of the organization and the environment of health care on this management.

Diagnostic study, design and implementation of an integrated model of care in France: a bottom-up process with continuous leadership

“…Projects implementing integrated care have taken centre stage as a way to improve quality and efficiency in care for the elderly [3,5]. But adoption of these integrated care models generates implementation problems, and it is difficult to secure the participation of professionals, particularly that of general practition ers (GPs) [6][7][8].…”

Potentially Avoidable Hospitalizations of Nursing Home Residents: Frequency, Causes, and Costs

“…The unreimbursed costs, as well as the potential regulatory and legal liabilities of caring for sicker residents, are potent disincentives to managing residents with acute changes in status in the NH. [19][20][21][22] Managed care programs such as Evercare and others mitigate these financial incentives and have been shown to reduce hospitalization of NH residents when teams of physicians and NPs or PAs provide more care in the NH, 14,23,24 but the number of NH residents in these programs remains small.…”

“…Involvement of NPs and PAs in collaboration with primary care physicians has repeatedly been shown to be associated with less hospitalization of NH residents. [12][13][14][23][24][25] Involving these health professionals in care transition interventions in which acute hospitals collaborate with NHs and home health agencies would build upon evolving models, 26,27 but the number of healthcare professionals with special training and interest in geriatrics and long-term care medicine is not increasing rapidly enough to meet this need. 28 Financial incentives to obtain certification in geriatrics or work in NHs, such as loan repayment programs, and the development of a specialty in NH medicine 29 may help in this regard.…”

Building Care Systems to Improve Access for High-Risk and Vulnerable Veteran Populations

“…Other research on homeless veterans noted reductions in emergency department use 24 and emergency department and inpatient use 25 with tailored clinic models, but only after the patients had been enrolled in the program for a least 6 months and in one study 18 months. Studies evaluating the Program of All-Inclusive Care for the Elderly (PACE) models found lower than predicted short term hospital use but with much inter-facility variation suggesting site-specific organization and management practices have an independent effect these findings 26 . Lastly, Pirraglia et al in an analysis of Veterans Administration hospitalization data found that sites with primary care co-located within mental health for patients with serious mental illness had significantly less ambulatory sensitive hospitalizations 27 .…”