The triage experiment in coordinated care for the elderly.

Abstract

Triage is a model project designed to overcome the organizational and financial barriers inhibiting the provision of appropriate care to the elderly. Teams made up of a nurse clinician and a social worker performed assessment, service coordination, and monitoring functions. Services arranged by the teams were financed through a series of waivers on the use of the Medicare Trust Fund. Three hundred and seven Triage clients were followed and compared to a group of 195 elderly in a two-year quasi-experimental The Triage Experiment: Project DescriptionTriage was designed as a model project for the coordinated delivery of medical and social services to the elderly. Unlike the conventional system, where the services provided to an individual depend upon what is available and reimbursable, the Triage system developed and organized services around the needs of the client and assured that these services were reimbursed. The purpose of the project was to test the effectiveness and measure the cost of this new system of delivering care to the elderly. A description of the project and preliminary first year (1977) findings have recently been reported by the authors.' This paper presents a more detailed description and findings from the full two years (1977)(1978) of comparative research.

Who Dies at Home? Determinants of Site of Death for Community‐Based Long‐Term Care Patients

“…During the time of this study, all case management was provided by a single organization. The assessment tool was modified from an original instrument developed as part of Triage, one of the first demonstrations of a Medicare waiver program, 8 and these data have been used in previous studies 9 . The assessment data were entered into a computer system with range checks, checks for internal consistency, and identification of missing data.…”

Factors Associated With Six‐Month Mortality in Recipients of Community‐Based Long‐Term Care

“…During the time of this study, all case management was provided by a single organization. The assessment tool was modified from an original instrument developed as part of Triage, one of the first demonstrations of a Medicare waiver program, 8 and assessment data have been used in earlier studies. Assessment data were entered into a computer system with range checks, checks for internal consistency, and identification of missing data.…”

Geriatric Patient Outcomes and Costs in Three Settings: Nursing Home, Foster Family, and Own Home

“…Evaluations of these expanded and case managed home services programs also reported similar patient improvement, slightly lower utilization of hospitals and nursing homes, and similar costs associated with patients in the experimental groups. One study made an interesting point when it reported significant cost savings only for the portion of patients who were most at‐risk of institutionalization 7–9 …”

“…Comparing patients in nursing homes and the two community settings, it was hypothesized that the patients in the two community settings would: 1) make at least equal progress in their ADL and mobility skills; 2) have comparable postplacement morbidity and hospitalization rates; 3) express greater well‐being; and 4) cost Medicaid less than the 75% cap on per patient expenditures. These hypotheses were based on past reports of equally good care and outcomes for community based and nursing home elders, of greater well‐being of patients participating in family structures versus institutional structures, and of the lower costs associated with New York's 2176 Waiver program 4,5,7–10,15 . Comparing the patients in the two community settings, it was hypothesized that foster home patients would: 1) make more improvement in ADL and mobility skills and 2) cost Medicaid less than would patients receiving NHWW services in their own homes.…”