作者：
Crome, PMalham, ABaker, DSmith, AEBloor, RKeele Univ
Postgrad Med Sch Dept Geriatr Med N Staffordshire Hosp Stoke On Trent ST4 7QB Staffs England Keele Univ
Postgrad Med Sch Dept Clin Audit N Staffordshire Hosp Stoke On Trent ST4 7QB Staffs England
In the early days of the British National Health Service, domiciliary visits were a continuation of the tradition whereby general practitioners (GPs) met consultants in the patient's home. The nature of domiciliar...
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In the early days of the British National Health Service, domiciliary visits were a continuation of the tradition whereby general practitioners (GPs) met consultants in the patient's home. The nature of domiciliary visits, which still attract a special fee, has since changed. We analysed the effectiveness of all domiciliary visits undertaken in a NHS trust providing primary care, mental health and elderly care services to a population of 470 000. Data were obtained from domiciliary visit claim forms and from questionnaires completed by the consultant, the referring GP and consultant peer reviewers. The largest number of visits (total 234) was in geriatric medicine 48.9%, followed by old-age psychiatry 44.9%. Geriatric medicine was more likely than psychiatry to admit patients to hospital (19%) after a visit. All domiciliary visits in old-age psychiatry were done during the day (9am to 5pm). Only 2% of Gps stated that they attended any of the domiciliary visits;almost all thought that the outcome of domiciliary visits was of value. Old-age-psychiatry peer reviewers believed that all visits in that specialty were appropriate;in geriatric medicine this figure was 77% and in other psychiatric specialties 65%. The findings indicate that domiciliary visits were not being used routinely as a pathway to hospital admission, though they were often used to expedite admission or gain a quick consultant opinion;the visits were valued by Gps. The practice of domiciliary visits differs greatly from the definition in NHS terms and conditions of service. One or other should be altered.
Objective: To describe the use of postacute services alone or in combination following a hospitalization for a hip fracture or stroke by Medicare beneficiaries who were relatively well and living in the community prio...
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Objective: To describe the use of postacute services alone or in combination following a hospitalization for a hip fracture or stroke by Medicare beneficiaries who were relatively well and living in the community prior to the index event. Methods: Health-service use histories were constructed using Medicare claims. Patients in the study represented all subjects from a 1% sample of Medicare beneficiaries who were age 70 years or older at the time of the index hospitalization. Results: From 1987 to 1992, the proportion of patients receiving any postacute care and those receiving combinations of care increased. For example, there was a doubling of the proportion of patients with either condition using sequences of rehabilitation with home health or SNF and home health. Within I year of the hospitalization, 42.6% of patients with stroke and 35.0% post-hip fracture had been rehospitalized. Discussion: Resource use and assessment of patient outcomes should be examined across the continuum of postacute care and in the months beyond to examine the relative effectiveness of different combinations of care.
The increasing percentage of frail, chronically ill, elderly in Wisconsin combined with a shift in the site of care delivery from institution to homes has created an increased need for non-skilled home health services...
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