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

Disclosures

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

In This Article

Discussion

The experience of the cooperative program between nursing homes and hospitals in Syracuse suggests that there is still a considerable potential for community-wide efforts to improve the accessibility and efficiency of care between settings. The initial experience of the program demonstrated that the accessibility and efficiency of healthcare increased measurably through reduced hospital stays and increased nursing home admissions of difficult-to-place patients. The structuring of this effort also indicates that competitive forces in healthcare can support the effectiveness of this type of program.

The combination of approaches to this situation that has been developed in Syracuse is based on the notion that long-term care providers need incentives to make the provision of care occur more expeditiously. The most important of these incentives has been the information collected and provided to nursing homes through increased hospital efforts and early identification of patients who require long-term care services. The intravenous and oral medication programs in Syracuse supplemented this information with limited, community-wide funding pools that could provide incentives for nursing home admission of specific types of patients.

From a competitive standpoint, this collection of mechanisms has provided incentives for hospitals and nursing homes to improve the accessibility and efficiency of care. For hospitals, the cooperative program has made a connection between early identification of patients requiring long-term care services and the potential for timely discharge of these individuals. In Syracuse, hospitals that have been most successful at early identification have generated the highest throughput of difficult-to-place patients. For nursing homes, the competitive incentive has been to admit more of these patients in return for more information concerning those with both rehabilitation potential and attractive payer statuses. The data summarized in this review demonstrate that some nursing homes in the community have experienced more success in meeting these objectives than others.

The fact that this program addressed a number of competitive incentives suggests that it could be implemented in a wide variety of communities nationwide. At the same time, the effort requires a basic level of cooperation among nursing homes and hospitals that could limit its generalizability. That level of cooperation is necessary to bring about the exchange of program data and other information.

Another important element of the cooperative program in Syracuse has been the continuous use of data to monitor its progress and stimulate performance by the participants. The distribution of lists of difficult-to-place patients twice each week has kept the issue of accessibility for these individuals before all providers in the community. The cooperative effort between acute care and long-term care providers in Syracuse is, admittedly, a work in progress. At the same time, it clearly demonstrates that a system of relatively simple, straightforward provider incentives can be used to improve the functioning of a healthcare system and increase the accessibility of care for the entire community. In a healthcare system and an economy that are increasingly challenged by resource constraints, this kind of approach is certainly worth pursuing.

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