A Community-wide Program to Improve the Efficiency of Care Between Nursing Homes and Hospitals

Ronald J. Lagoe, PhD; Janet Dauley-Altwarg, JD, MHA; Saundra E. Mnich, MSN, RN-C; Lynn M. Winks, RN, AAS


Topics in Advanced Practice Nursing eJournal. 2005;5(2) 

In This Article

Abstract and Introduction


Context: The program was an effort to work cooperatively, made by caregivers from both acute care and long-term care facilities in a community-wide setting of competing providers.
Objective: The objective of the program was to improve the outcomes and efficiency of the community healthcare system by expediting the movement of patients to appropriate services.
Design/Interventions: The program included a system efficiency project that provided timely identification of appropriate patients with attractive payer statuses to nursing homes in return for admission of difficult-to-place patients. The program also included a community-wide pool to fund intravenous antibiotic therapy and high-cost oral and subcutaneous medications in nursing homes.
Setting: The program was implemented in the metropolitan area of Syracuse, New York, which includes 4 general hospitals, 12 nursing homes, and a population of approximately 590,000.
Main Outcome Measures: The principal outcomes evaluated included hospital lengths of stay for all patients discharged to nursing homes and numbers of patients for the medication program.
Results: The program resulted in a 14.3% reduction in number of days per hospital stay for patients discharged to nursing homes between January 2002 and March 2004. During the same period, the mean census of nonacute, alternate care patients in the community declined by 60.9%, from 28.9 to 11.3. During the first year of implementation, the intravenous antibiotic program served 48 patients, 30% of the estimated number of candidates. The implementation of the high-cost oral and subcutaneous medications program appeared to have reduced the numbers of nonacute patients in hospitals.
Conclusion: Results of the program suggested that improvements in accessibility and efficiency of long-term care and related services could be achieved through incentives that fit the realities of a competitive healthcare system. These mechanisms included a process to make attractive patients more accessible to nursing homes, as well as a method to program development funding for appropriate patients.


During the 1980s, a number of communities in the United States implemented mechanisms for coordinating long-term care and acute care services in order to reduce hospital utilization and costs[1,2] through programs emphasizing cooperation among providers. Surveys have indicated that, although these projects expanded the use of home care and other services, they failed to produce significant reductions in hospital use.[3,4]

Since the 1980s, interest in community-wide approaches for coordinating long-term care and hospital services based on cooperation has waned. Some systemwide efforts continued to be pursued, such as Ohio's OPTIONS for Elders program, which involved a single point of entry, care management, and other components,[5] and Manitoba's (Ontario, Canada) program for assessment and care coordination of long-term care patients.[6] Other efforts at coordination of services have focused on disease management involving individual diagnoses, such as Alzheimer's disease[7] or diabetes,[8] or within individual provider networks.[9,10]

It appears that much of the focus on individual diagnoses and networks in the coordination of long-term care services may have been generated by the competitive approach to healthcare that marked the 1990s. As competition intensified at the local level, attention turned away from community-wide solutions and toward provider-specific ones. This situation has been complicated by increased pressure on the Medicare and Medicaid budgets.[11]

Recent experience suggests that the competitive model can create renewed interest in approaches to coordinating services.[12] This direction could combine the benefits of previous experience with lessons from the competitive model. This study describes one recent community-wide approach in Syracuse, New York.


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