Patterns of Utilization for the Minnesota Senior Health Options Program

Kane, Robert L; Homyak, Patricia; Bershadsky, Boris; Flood, Shannon; Zhang, Hui

doi:10.1111/j.1532-5415.2004.52558.x

Cited by 23 publications

(19 citation statements)

References 8 publications

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“…43 Many studies of outpatient geriatric assessment and of community and home-based care management have failed to demonstrate lower acute care utilization rates. [16][17][18][19]38,40,44,45 Prior successful studies and the current trial, however, provide evidence that ED visits and hospital utilization can be reduced through a geriatrics interdisciplinary team that provides ongoing care management (usually including home visitation) in support of and integrated with the primary care physician. 15,[46][47][48][49] There may be a "period of engagement" before utilization rates decline.…”

Section: Geriatric Care For Low-income Seniorsmentioning

confidence: 85%

Geriatric Care Management for Low-Income Seniors

Counsell¹,

Callahan²,

Clark³

et al. 2007

JAMA

453

500

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Section: Geriatric Care For Low-income Seniorsmentioning

confidence: 85%

Geriatric Care Management for Low-Income Seniors

Counsell¹,

Callahan²,

Clark³

et al. 2007

JAMA

453

500

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“…The Chronic Care Model posits that redesign of the delivery system, enhanced decision support, improved clinical information systems, support for self-management, and better access to community resources will improve outcomes for people with chronic conditions (Bodenheimer, Wagner, & Grumbach, 2002). In support of the chronic care model, studies have shown that innovations in these domains can improve clinical and/or financial outcomes in outpatient settings (Boult et al, 2001;Cohen et al, 2002;Phelan, Williams, Penninx, LoGerfo, & Leveille, 2004;Reuben, Frank, Hirsch, McGuigan, & Maly, 1999;Sommers, Marton, Barbaccia, & Randolph, 2000;Unutzer et al, 2002), in hospitals (Landefeld, Palmer, Kresevic, Fortinsky, & Kowal, 1995), in emergency departments (Miller, Lewis, Nork, & Morley, 1996), in nursing homes (Joseph & Boult, 1998;Kane, Homyak, Bershadsky, Flood, & Zhang, 2004;Reuben, Schnelle, et al, 1999), in the home (Stuck, Egger, Hammer, Minder, & Beck, 2002), and during transitions between sites of care (Naylor et al, 1999). Likewise, interventions that focus on the caregivers of individuals with dementia have delayed nursing home placement (Mittelman, Ferris, Shulman, Steinberg, & Levin, 1996) and improved caregivers' well-being (Mittelman, Roth, Coon, & Haley, 2004).…”

Section: Conceptual Basismentioning

confidence: 99%

Guided Care for Multimorbid Older Adults

Boyd¹,

Boult²,

Shadmi³

et al. 2007

The Gerontologist

180

193

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Purpose: The purpose of this study was to test the feasibility of a new model of health care designed to improve the quality of life and the efficiency of resource use for older adults with multimorbidity. Design and Methods: Guided Care enhances primary care by infusing the operative principles of seven chronic care innovations: disease management, self-management, case management, lifestyle modification, transitional care, caregiver education and support, and geriatric evaluation and management. To practice Guided Care, a registered nurse completes an educational program and uses a customized electronic health record in working with two to five primary care physicians to meet the health care needs of 50 to 60 older patients with multimorbidity. For each patient, the nurse performs a standardized comprehensive home assessment and then collaborates with the physician, the patient, and the caregiver to create two comprehensive, evidencebased management plans: a Care Guide for health care professionals, and an Action Plan for the patient and caregiver. Based in the primary care office, the nurse then regularly monitors the patient's chronic conditions, coaches the patient in self-management, coordinates the efforts of all involved health care professionals, smoothes the patient's transitions between sites of care, provides education and support for family caregivers, and facilitates access to community resources. -Results: A 1-year pilot test in a community-based primary care practice suggested that Guided Care is feasible and acceptable to physicians, patients, and caregivers. Implications: If successful in a controlled trial, Guided Care could improve the quality of life and efficiency of health care for older adults with multimorbidity.

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“…A study of PACE concluded that hospitalization rates among PACE members are similar to hospitalization rates among all Medicare beneficiaries even though PACE has a more disabled population (Wieland et al 2000). A program with similar risk contracting in Minnesota was found to be associated with fewer hospitalizations, but the lower hospitalization rate was attributed to members in nursing homes with Evercare contracts; the capitated payment itself could not be associated with reductions in hospitalization beyond what was already attributable to Evercare (Kane et al 2004). The Minnesota program involved a looser structure than the PACE program, suggesting that aligning financial incentives is necessary but not sufficient for reducing hospitalizations.…”

Section: Policy Interventionsmentioning

confidence: 99%

Reducing Hospitalizations From Long-Term Care Settings

2007

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Hospital spending represents approximately one third of total national health spending, and the majority of hospital spending is by public payers. Elderly individuals with long-term care needs are at particular risk for hospitalization. While some hospitalizations are unavoidable, many are not, and there may be benefits to reducing hospitalizations in terms of health and cost. This article reviews the evidence from 55 peer-reviewed articles on interventions that potentially reduce hospitalizations from formal long-term care settings. The interventions showing the strongest potential are those that increase skilled staffing, especially through physician assistants and nurse practitioners; improve the hospital-to-home transition; substitute home health care for selected hospital admissions; and align reimbursement policies such that providers do not have a financial incentive to hospitalize. Much of the evidence is weak and could benefit from improved research design and methodology.

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Patterns of Utilization for the Minnesota Senior Health Options Program

Cited by 23 publications

References 8 publications

Geriatric Care Management for Low-Income Seniors

Geriatric Care Management for Low-Income Seniors

Guided Care for Multimorbid Older Adults

Reducing Hospitalizations From Long-Term Care Settings

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