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On-site care improves seniors' health

By Roger P. Smith, Ph.D.

Bynum studied four retirement communities.

Nationwide, the construction of retirement communities is a growth industry (and the Upper Valley is no exception). For people thinking of moving to such a community, an important consideration is the kind of health care they can expect to receive.

Researchers from the Dartmouth Institute for Health Policy and Clinical Practice recently compared two models of health-care delivery at continuing-care retirement communities. The study, led by geriatrician Julie Bynum, M.D., examined four sites operated by a single corporation. At each site, residents enter while living independently but have lifetime access to assisted-living and nursing-home care. The four sites provide similar social and residential support but have different models of health care.

Site: At three of the sites, primary-care physicians from surrounding areas make scheduled clinic visits. After-hours care is provided either by those physicians or other physicians from their group practices, including some who don't otherwise see patients from the retirement communities. The fourth site follows a different model, in which physicians are "embedded" within the retirement community. A small group of doctors provides all the care to residents, offering an outpatient clinic, care at the on-site nursing home, and home visits. These doctors are the only doctors providing care at the community, including after-hours care, and they do not see patients outside the facility.

Use: To be included in the study, residents had to be at least 75 years old and be enrolled in traditional fee-for-service Medicare (rather than in a Medicare Advantage plan). Almost all residents of the communities fit those criteria. The researchers analyzed the residents' use of health care by examining Medicare records from 1997 to 2006, and they interviewed staff at each site to learn more about the organization of care.

Only 5% of residents with embedded care died in a hospital.

As Bynum and her colleagues reported in Health Affairs, residents of the community served by a dedicated team of doctors had lower rates of hospital and emergency room use and were less likely to die in a hospital. Only 5% of residents in the community with embedded care died in a hospital, compared to about 15% of those at the other three communities (and about 27% of all Americans over 75).

Care: And residents in the community with embedded care made, on average, three visits to specialists a year, compared to over six for residents of the other three sites. The rate of hospital admissions was 15 per year per 100 residents at the embedded community, but ranged from 25 to 30 per 100 residents at the other sites.

"Our findings are exactly what one would hope to see . . . when a primary-care practice is focused on resident care and goals," Bynum says. "The exciting thing is that the embedded model is exportable to all . . . facilities."

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