Friday, April 10, 2009

Nursing Home Care- A Literature review

Here are some interesting articles highlighting some problems related to lack of physician availability to care for nursing patients in the current health care system.

Although this is a blog with a primary focus on health IT, it is important to have a clear understanding of the problems faced by practitioners in order to create an IT solution.

I have listed some key information from my literature search

..."the quality of care in nursing homes remains inconsistent and in many respects suboptimal."
11. Scanlon WJ. Nursing Homes: Prevalence of Serious Quality Problems Remains Unacceptably High, Despite Some Decline. Testimony before the Committee on Finance, U.S. Senate, GAO 03-1016T, 17 July 2003)

A case for Nursing Home Physician Specialists in the Annals of Internal Medicine, March 2009

Marginal physician involvement impedes communication and integration of the physician into the nursing home culture, with detrimental patient outcomes (36–38).

Nursing home practice is only 4% of work time among the 20% of physicians who practice in a nursing home, one third of whom are internists (12). Often rooted in reality, perceptions among nursing home physicians of excessive regulation, paperwork, professional liability, and lack of nursing support remain barriers to developing a widespread nursing home specialist culture (13). Perhaps more important, many physicians still find it difficult to overcome logistic challenges (for example, caring for a sufficient number of patients while traveling from one facility to another), even though reimbursement for nursing home visits has increased. Without salary derived from administrative duties associated with being a medical director, many practitioners find nursing home care untenable. Waning interest in primary care and geriatrics (14), coupled with few credible role models (15), further constrains physician involvement in nursing homes. In a survey of graduating residents, fewer than 15% felt "very prepared to provide nursing home care" (16). .

1997 Study on Nursing Home Medical Practice

RESULTS: Most (77%) physicians reported spending no measurable time caring for nursing home patients

CONCLUSIONS: With increasing numbers of older and frailer residents, nursing homes will continue to be integral components of the future healthcare system. However, physicians currently spend minimal time caring for nursing home patients, with physician characteristics best predicting involvement. Questions remain about the future of nursing home medical practice and how to best recruit, staff, and train future cadres of physicians to provide sufficient quality care for nursing home patients in an evolving health care system.

Physician involvement in nursing home patient care is important in decreasing needless hospital admissions and in improving outcomes:

"Physician care positively influences residents' hospitalization rates, functional status, and satisfaction (33–35). Marginal physician involvement impedes communication and integration of the physician into the nursing home culture, with detrimental patient outcomes"

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